title: Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of re-exploration for bleeding after cardiac surgery on the immediate postoperative outcome.
  
  
  METHODS
  Systematic review of the literature and meta-analysis of data on re-exploration for bleeding after adult cardiac surgery were performed.
  
  
  RESULTS
  The literature search yielded eight observational studies reporting on 557,923 patients and were included in the present analysis. Patients requiring re-exploration were significantly older, more frequently males, had a higher prevalence of peripheral vascular disease and preoperative exposure to aspirin, and more frequently underwent urgent/emergency surgery. Re-exploration was associated with significantly increased risk ratio (RR) of immediate postoperative mortality (RR 3.27, 95% confidence interval (CI) 2.44-4.37), stroke, need of intra-aortic balloon pump, acute renal failure, sternal wound infection, and prolonged mechanical ventilation. The pooled analysis of four studies (two being propensity score-matched pairs analysis) reporting adjusted risk for mortality led to an RR of 2.56 (95%CI 1.46-4.50). Studies published during the last decade tended to report a higher risk of re-exploration-related mortality (RR 4.30, 95%CI 3.09-5.97) than those published in the 1990s (RR 2.75, 95%CI 2.06-3.66).
  
  
  CONCLUSIONS
  This study suggests that re-exploration for bleeding after cardiac surgery carries a significantly increased risk of postoperative mortality and morbidity.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Reija
authors.initials: R
authors.lastname: Mikkola
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment / Q000379:methods