Frequency of Reoperation due to Bleeding and Its Related Factors After Adult Cardiac Surgeries

Document Type : Original Article

Authors

1 Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Department of Cardiac Surgery, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Tehran, IR Iran.

3 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Reoperation due to bleeding in adult cardiac surgeries is an important postoperative complication that increases mortality and morbidity. Studying the risk factors and outcomes of reoperation in these patients is imperative.
 
Methods: The present descriptive (cross-sectional) study performed a 3-month assessment of patients that underwent elective cardiac surgeries (coronary or valve surgeries or both). The inclusion criterion was being an adult undergoing elective cardiac surgeries on cardiopulmonary bypass (coronary or valve surgeries or both), and the exclusion criteria consisted of congenital heart diseases, cardiac surgeries without cardiopulmonary bypass, emergency cardiac surgeries, aneurysm and aortic dissection surgeries, known causes of bleeding due to acquired or congenital diseases, and redo cardiac surgeries.
 
Results: Of 740 patients studied, 55 (7.43%) patients returned to the operating room due to bleeding. Of these 55 patients, 74.5% had bleeding due to surgical operations, 23.6% due to tamponade, and 1.8% due to coagulation disorders. Apropos risk factors, there was a significant relationship between the international normalized ratio (INR) and bleeding after cardiac surgeries leading to reoperation (p = 0.05).
 
Conclusions: In this study, 7.43% of the patients returned to the operating room because of bleeding, which is an acceptable percentage according to the literature. There was a significant relationship between preoperative INR and postoperative bleeding resulting in reoperation. (Iranian Heart Journal 2020; 21(4): 85-92)
 

Highlights

 

 

Keywords


 

 
  1. G1 Loor, Vivacqua A, Sabik 3rd JF, Li L, Hixson ED, Blackstone EH, et al. Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist. J ThoracCardiovascSurg 2013Nov; 146(5):1028e32.
  2. Rajendra H. Mehta, MD, MS; Shubin Sheng, MS; Sean M. O’Brien, PhD; Frederick L. Grover, MD; James S. Gammie, MD; T. Bruce Ferguson, MD; Eric D. Peterson, MD, MPH, Reoperation for Bleeding in Patients Undergoing Coronary Artery Bypass Surgery Incidence, Risk Factors, Time Trends, and Outcomes (CircCardiovascQual Outcomes. 2009; 2:583-590.)
  3. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ et al Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann ThoracSurg 2006; 81:1650–7 PMID:16631651
  4. Ferraris VA, Ferraris SP, Saha SP, Hessel II EA, Haan CK, Royston BD, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline* The Society of Thoracic Surgeons Blood Conservation Guideline Task Force. Ann ThoracSurg 2007; 83: S27–86 PMID: 1746245
  5. Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg 2014; 147:1458–63 doi: 10.1016/j.jtcvs.2013.10.070 PMID: 24332097
  6. Vuylsteke A, Pagel C, Gerrard C, Reddy B, Nashef S, Aldam P et al. The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding. Eur J Cardiothorac Surg 2011; 39:924–931 doi: 10.1016/j.ejcts.2010.10.003 PMID:21094051
  7. Choong CK et al. Delayed re-exploration for bleeding after coronary artery bypass surgery results in adverse outcomes // Eur J Cardiothorac Surg, 2007; 31:834 – 8
  8. Hall TS et al. Re-exploration for hemorrhage following open heart surgery differentiation onthe causes of bleeding and the impact on patient outcomes // Ann Thorac Cardiovasc Surg, 2001;7:352 – 7
  9. AgneseOzolina, Eva Strike, Vladimirs Harlamovs, Nora PoritePaulsStradins Clinical University Hospital, Department of Anesthesiology and Cardiothoracic Surgery, Riga, LatviaExcessive Bleeding After Cardiac Surgery in Adults: Reasons and Management. ACTACHIRURGICA LATVIENSIS • 2009 (9). DOI: 10.2478/v10163-010-0017-2
  10. Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, Yusuf S; Clopidogrel in Unstable angina to prevent Recurrent ischemic Events Trial. Benefits and risks of the combination of clopidogrel in patients undergoing surgical revascularization for Non-ST elevation acute coronary syndromes; The Clopidogrel in unstable angina to prevent recurrent ischemic events (CURE) trial. Circulation.2004; 110: 1202–1208.
  11. Kapetanakis EI, Mediam DA, Boyce SW, Haile E, Hill PC, Dullum MKC, Bafi AS, Petro KR, Corso PJ. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist’s panacea or the surgeon’s headache? Eur Heart J. 2005; 26:576 –583.
  12. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann ThoracSurg2004; 78:527–34.
  13. Hall TS, Brevetti GR, Skoultchi AJ, Sines JC, Gregory P, Spotnitz AJ. Reexploration for hemorrhage following open heart surgery differentiationon the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg 2001;7:352–7.
  14. Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A. Surgical reexploration after cardiac operations: why a worse outcome. Ann ThoracSurg2008; 86:1557–62.
  15. Ranucci M et al. Surgical reexploration after cardiac operations: why a worse outcome // Ann ThoracSurg, 2008; 86:1557 – 62
  16. Dunne JR et al. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery // J Surg Res, 2002; 102:237 – 44
  17. Pascal H. Colson1, Philippe Gaudard1, Jean-Luc Fellahi, HélénaBertet, Marie Faucanie, Julien Amour, Yvonnick Blanloeil, Hervé Lanquetot, Alexandre Ouattara, Marie Christine Picot, ARCOTHOVA group.Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study. PLOS ONE | DOI: 10.1371/journal.pone.0162396 September 2, 2016
  18. Vuylsteke A, Pagel C, Gerrard C, Reddy B, Nashef S, Aldam P et al. The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding. Eur J Cardiothorac Surg 2011; 39:924–931 doi: 10.1016/j.ejcts.2010.10.003 PMID:21094051
  19. Katrine Lawaetz Kristensen, Line Juul Rauer, Poul Erik Mortensen and Bo Juel Kjeldsen. Reoperation for bleeding in cardiac surgery. Interactive CardioVascular and Thoracic Surgery 14 (2012) 709–713
  20. Hirose H, Takahashi A. Re-exploration for bleeding after coronary artery bypass grafting: what is the acceptable range of re-exploration rate // Ann ThoracCardiovascSurg, 2002; 8:248 - 9; author reply 249.
  21. Karthik S et al. Reexploration for bleeding after coronary artery bypass surgery: risk factors,outcomes, and the effect of time delay // Ann ThoracSurg, 2004; 78:527 - 34; discussion 534
  22. Karkouti K et al. Prediction of massive blood transfusion in cardiac surgery. Can J Anaesth, 2006;53:781 – 94
  23. Chen L et al. Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting //J ThoracCardiovascSurg, 2004; 128:425 – 31
  24. Sirvinskas E et al. Influence of early re-infusion of autologous shed mediastinal blood on clinical outcome after cardiac surgery // Perfusion, 2007; 22:345 – 52
  25. Salis S et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortalityafter cardiac surgery // J CardiothoracVascAnesth, 2008; 22:814-22