[Bleeding after cardiac surgery: risk factors, frequency, and outcomes].
According to the data from different cardiac surgery centers, the incidence of urgent repetitive resternotomy for bleeding after cardiac on-pump operations varies from 2 to 5%. The aim of the study was to determinate the risk factors influencing resternotomy after cardiac surgery, features of early postoperative period, and outcomes.


METHODS
Altogether, 37 consecutive patients undergoing urgent resternotomy due to bleeding early after cardiac surgery were analyzed retrospectively. Urgent resternotomies made up 4.3% of all cardiac on-pump surgeries performed on 856 patients at the Clinic of Cardiac Surgery of Kaunas University of Medicine Hospital during 2004. The mean age of patients was 64.9+/-12.9 years; 29.7% of patients were women and 70.3% were men.


RESULTS
During analysis of preoperative clinical data factors that could influence coagulation status were determined. Twenty patients (54.1%) had moderate hypertension, three patients (8.1%) had severe insulin-dependent diabetes mellitus, and five patients (13.5%) had chronic renal insufficiency treated with dialysis. Assessing other risk factors it was observed that many patients were on peroral anticoagulation therapy before surgery. The most frequently administered drugs preoperatively were aspirin (16 cases, 43.2%) and direct-acting anticoagulants (17 cases, 45.9%).


CONCLUSIONS
The use of antiaggregants and anticoagulants before surgery increases the incidence of resternotomies in the early postoperative period. Postoperative infections that require more expensive treatment with antibiotics are detected much more frequently in patients after resternotomies comparing to the remaining postoperative cardiac patients (15/37 and 69/819, respectively). However, longer hospitalization length (15.8 and 58.0 days, respectively) and higher mortality rate (4.5 and 10.8%, respectively) were observed in patients after resternotomy.
Kinduris
Sarūnas
S
Institute for Biomedical Research, Heart Center, Kaunas University of Medicine, Lithuania. kinsar@one.lt
Vaisvila
Tautvydas
T
Petronyte
Jurgita
J
Budrikis
Algimantas
A
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004630:Emergencies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D001241:Aspirin