Resternotomy for bleeding after cardiac operation: A marker for increased morbidity and mortality

Over a 2-year period from January 1, 1992, to December 31, 1993, of 2,221 patients undergoing cardiac operations in our unit, 85 (3.8%) were reopened for the control of bleeding (9 patients more than once). The incidence of resternotomy in coronary cases was 2.3%, but resternotomy was more than thre...

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Published in:	The Annals of thoracic surgery Vol. 59; no. 3; pp. 664 - 667
Main Authors:	Jonathan Unsworth-White, M., Herriot, Alexander, Valencia, Oswaldo, Poloniecki, Jan, John Smith, E.E., Murday, Andrew J., John Parker, D., Treasure, Tom
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-03-1995 Elsevier Science
Subjects:	Aged Biological and medical sciences Blood Loss, Surgical Cardiac Surgical Procedures - adverse effects Cardiotonic Agents - therapeutic use Female Hemofiltration Hemostasis, Surgical - methods Humans Incidence Male Medical sciences Middle Aged Morbidity Postoperative Complications - drug therapy Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Prospective Studies Regression Analysis Reoperation Risk Factors Sternum - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Treatment Outcome Heart Human Sternotomy Reoperation Treatment Surgery Mortality Cardiovascular disease Complication Hemorrhage Morbidity
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Summary:	Over a 2-year period from January 1, 1992, to December 31, 1993, of 2,221 patients undergoing cardiac operations in our unit, 85 (3.8%) were reopened for the control of bleeding (9 patients more than once). The incidence of resternotomy in coronary cases was 2.3%, but resternotomy was more than three times as likely in valve cases (odds ratio, 3.4; 95% confidence interval, 2.1 to 5.4). Previous cardiac operation was more common among resternotomy patients than among the remainder (18% versus 9%, respectively; p = 0.018). An identifiable source of bleeding was found in 57 of the 85 patients (67%), but a concurrent coagulopathy was common (45 patients). Resternotomy patients, as a group, had higher preoperative risk scores (Parsonnet) than did the other patients ( p < 0.0001), stayed longer in the intensive care unit ( p < 0.0001), and had greater requirements for intraaortic balloon counterpulsation (14% versus 3%) and hemofiltration (9% versus 3%) ( p < 0.0001 and p < 0.01, respectively). Nineteen resternotomy patients (22%) died in the hospital, a proportion significantly greater than the risk assigned to this group of patients preoperatively (12.8%) ( p = 0.008). In contrast, the observed mortality for the other 2,136 patients (5.5%) was significantly less (8.3%) ( p < 0.00006). Multiple forward stepwise logistic-regression analysis confirmed resternotomy for excessive bleeding after cardiac operation to be a significant independent predictor of a prolonged stay in the intensive care unit ( p < 0.0001), the need for intraaortic balloon counterpulsation ( p < 0.0001), and death ( p < 0.0001).
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/0003-4975(94)00995-3