[Reexploration for bleeding and tamponade in intensive care unit following open heart surgery].
OBJECTIVE
Following open-heart surgery some patients can need reexploration in the intensive care unit due to bleeding or pericardial tamponade. This study evaluates the impact of reexploration in the intensive care unit (ICU) on morbidity and mortality rates.


METHODS
Between January 1990 and January 2002 overall 18,578 open heart surgery procedures were performed in our clinic and among them 570 (3%) patients required reexploration due to bleeding or pericardial tamponade. Reexplorations were done in the operating room (OR) in 385 (67.5%) patients and in the ICU in 185 (32.5%) patients.


RESULTS
Among patients 383(67.2%) were male and 187(32.8%) were female. Mean age for reexploration in the OR group was 46.9+/-16.3 years, and in the ICU group was 48.2+/-15.7 years. The use of fresh frozen plasma and bank blood was significantly higher in the ICU group (p<0.0001). Fifty patients (27%) who were reexplored in ICU had intraaortic balloon pump (IABP) support (p<0.0001). Sixty-six patients (17.1%) died in OR group and 70 patients (37.8%) died in the ICU group (p<0.001). Following reexploration, 24 (6.2%) patients in the OR group and 17 (9.1%) patients in the ICU group had major infection (p>0.05). There was no statistically significant difference among groups in hospital stay time.


CONCLUSIONS
Following open-heart surgery, especially among hemodynamically unstable patients, to avoid possible problems of transfer to the OR and time lost, explorations can be done in ICU. This practice does not increase morbidity and hospital stay.
Ozatik
Mehmet Ali
MA
Türkiye Yüksek Ihtisas Eğitim ve Araştirma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Ankara. maozatik@yahoo.com
Göl
Kamil
K
Budak
Baran
B
Küçüker
Seref
S
Saritaş
Ahmet
A
Mavitaş
Binali
B
Sener
Erol
E
Taşdemir
Oğuz
O
D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D014421:Turkey / Q000453:epidemiology