Publication: Incidence and Outcomes of Re-Exploration in Adult Cardiac Surgery at A Tertiary Care Hospital
Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
Institute of Medicine
Abstract
ABSTRACT
Introduction: Postoperative bleeding is a significant complication following cardiac surgery, with a global re-exploration incidence of 2-5%. This study aims to investigate re-exploration rates, risk factors, and outcomes within the unique context of a tertiary care center in Nepal.
Methods: In this retrospective, single-center study, we analyzed all consecutive adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass (CPB) at the Manmohan Cardiothoracic Vascular and Transplant Centre (Nepal) between 2018-2021. Data on demographics, clinical characteristics, operative details, re-exploration, and outcomes were extracted from medical records. Statistical analysis included descriptive statistics, chi-square tests, independent samples t-tests, and logistic regression.
Results: Of 720 patients, 56 (7.8%) required re-exploration for bleeding. Emergency procedures were strongly associated with higher re-exploration (p<0.05). Non-surgical bleeding was the primary cause in 42.9% of cases. Independent risk factors included preoperative deranged LFTs (OR=2.1, 95% CI: 1.2-3.7), elevated creatinine (>1.5 mg/dL, OR= 3.2, 95% CI: 1.8-5.6), prolonged CPB time (>120 min), and substantial transfusion requirements. Modified Bentall's procedures had the highest re-exploration rate (21.4%). Re-explored patients experienced higher AKI rates (87.5%), longer hospitalizations (13.6 vs. 7.2 days, p<0.001), and increased in-hospital mortality confined to emergency cases (1.94%).
Conclusion: Emergency procedures had higher rate of re-exploration. Preoperative deranged LFTs, elevated creatinine, prolonged CPB time, and substantial transfusion requirements were independent risk factors for re-exploration. Re-explored cases experienced higher complication. In-hospital mortality were confined to emergency cases only.
Keywords: Bleeding; cardiac surgery; emergency surgery; modified Bentall’s procedure; re-exploration
Description
Ashok Pradhan, Rojina Pokharel, Prashiddha B Kadel, Krishnaprashad Bashyal, Prabhat Khakural, Ravi K Baral, Anil Bhattarai, Bhagawan Koirala
Department of Cardiothoracic Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic vascular and Transplant Centre, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
Keywords
Bleeding, cardiac surgery, emergency surgery, modified Bentall’s procedure, re-exploration