Damien J LaPar1, James M Isbell1, Daniel P Mulloy1, Matthew L Stone1, John A Kern1, Gorav Ailawadi1, Irving L Kron2. 1. The Virginia Interdisciplinary Cardiothoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. 2. The Virginia Interdisciplinary Cardiothoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: ilk@virginia.edu.
Abstract
BACKGROUND: Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. METHODS: All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. RESULTS: 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU=75% and unplanned ICU=18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p<0.001) and incurred higher observed mortality (37% vs 6%, p<0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p=0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR=26.6 [7.1, 99.7], p<0.001) compared with planned ICU reexplorations. CONCLUSIONS: Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.
BACKGROUND: Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. METHODS: All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. RESULTS: 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU=75% and unplanned ICU=18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p<0.001) and incurred higher observed mortality (37% vs 6%, p<0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p=0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR=26.6 [7.1, 99.7], p<0.001) compared with planned ICU reexplorations. CONCLUSIONS: Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.
Authors: Vance G Fowler; Sean M O'Brien; Lawrence H Muhlbaier; G Ralph Corey; T Bruce Ferguson; Eric D Peterson Journal: Circulation Date: 2005-08-30 Impact factor: 29.690
Authors: Fausto Biancari; Reija Mikkola; Jouni Heikkinen; Jarmo Lahtinen; K E Juhani Airaksinen; Tatu Juvonen Journal: Eur J Cardiothorac Surg Date: 2012-01 Impact factor: 4.191
Authors: G Ottino; R De Paulis; S Pansini; G Rocca; M V Tallone; C Comoglio; P Costa; F Orzan; M Morea Journal: Ann Thorac Surg Date: 1987-08 Impact factor: 4.330
Authors: E A Grossi; A T Culliford; K H Krieger; D Kloth; R Press; F G Baumann; F C Spencer Journal: Ann Thorac Surg Date: 1985-09 Impact factor: 4.330
Authors: Juri Sromicki; Mathias Van Hemelrijck; Martin O Schmiady; Bernard Krüger; Mohammed Morjan; Dominique Bettex; Paul R Vogt; Thierry P Carrel; Carlos-A Mestres Journal: Interact Cardiovasc Thorac Surg Date: 2022-06-15