Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes

Objective: We aimed to identify the impact of re-exploration for bleeding after coronary artery bypass grafting (CABG) and the effect of time delay, re-exploration within 12 h (< 12 h) versus 12 h or later (>= 1 2 h). Methods: Analyses of prospective clinical data on 3220 consecutive patients who underwent CABG between 2003 and 2005 were performed. Pearson chi(2) tests, Fisher's exact tests, Student's t-tests, Mann-Whitney U tests, or univariate logistic regression analysis were used to assess the effects of pre-operative and operative characteristics on re-exploration, and the effects of re-exploration and time delay on adverse outcomes. Predictors of re-exploration and its effect on adverse outcomes were further evaluated using multiple logistic regression analysis. Results: One hundred ninety-one patients (5.9%) underwent re-exploration for bleeding. Re-explored patients as a group in comparison to the non-re-explored group had increased postoperative blood loss, transfusion requirements, duration of mechanical ventilation, ICU stay, intra-aortic balloon pump (IABP) and haemofiltration support, and mortality(all p < 0.001). One hundred fifty-seven (82%) of the 191 patients were re-explored < 12 h. The group of patients who were re-explored < 12 h in comparison to >= 12 h group had shorter ICU stay (median 3 vs 8.5 days; p < 0.001), less IABP support (22.3 vs 44.1%; p = 0.009) and a lower mortality (7 vs 29.4%; p = 0.001). There was no significant difference in blood loss or transfusion requirements between the two groups. The predicted EuroSCORE risks of the < 12 h group was 6.66% and the observed mortality was 7% (p = 0.865). The observed mortality of 29.4% in the >= 1 2 h group was significantly higher than the predicted EuroSCORE risks of 7.59% (p < 0.001). Conclusions: Patients requiring re-exploration for bleeding are at higher risk of adverse outcomes and this risk is increased if time to re-exploration is prolonged for 12 h or longer. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.