Early Reexploration for Bleeding Is Associated With Improved Outcome in Cardiac Surgery

BACKGROUND Reexploration after cardiac surgery, most frequently for bleeding, is a quality metric used to assess surgical performance. This may cause surgeons to delay return to the operating room in favor of attempting nonoperative management. This study investigated the impact of the timing of reexploration on morbidity and mortality.METHODS This study was a single-institution retrospective review of all adult cardiac surgery patients from July 2010 to June 2020. Time to reexploration was assessed, and outcomes were compared across increasing time intervals. Reported bleeding sites were classified into 5 groups, and bleeding rate (chest tube output) was compared across bleeding sites. Univariable analysis was performed using the Fisher exact and Kruskal-Wallis tests. Multivariable logistic regression models were used for risk-adjusted analyses.RESULTS Of 10070 eligible patients, 251 (2.5%) required reexploration for postoperative bleeding. The most common site of bleeding was any suture line (n = 70; 28%). Interestingly, in 30% of cases (n = 75) no active bleeding site was reported. The highest rate of bleeding (mL/h) was observed in the any mediastinal structure group (median, 450; interquartile range [IQR], 185, 8878), and the lowest rate was noted in the no active bleeding group (median, 151.2; IQR, 102, 270). Both morbidity rates (0-4 hours, 12.3% vs 25-48 hours, 37.5%; P = .001) and mortality rates (0-4 hours, 3.1% vs 25-48 hours, 43.8%; P = .001) escalated significantly with increasing time to reexploration.CONCLUSIONS Delayed reexploration for bleeding after cardiac surgery is associated with increased risk for morbidity and mortality. Early surgical intervention, particularly within 4 hours, may improve outcomes. Implications from using reoperation as a performance metric may lead to unnecessary delay and patient harm.

Automated summary

This study investigated the impact of the timing of reexploration after cardiac surgery on morbidity and mortality. It found that delayed reexploration is associated with increased risk for complications and death. Early surgical intervention, particularly within 4 hours, may improve outcomes. Using reexploration as a performance metric may lead to unnecessary delay and patient harm.