title: Re-exploration for bleeding or tamponade after cardiac surgery: impact of timing and indication on outcome.
abstract: OBJECTIVE
  Re-exploration after cardiac surgery remains a frequent complication with adverse outcomes. The aim of this study was to evaluate the impact of timing and indication of re-exploration on outcome.
  
  
  METHODS
  A retrospective, observational study on a cohort of 209 patients, who underwent re-exploration after cardiac surgery between January 2005 and December 2011, was performed. The cohort was matched for age, gender, and procedure with patients who were not re-explored during the same period.
  
  
  RESULTS
  The intraoperative and postoperative transfusion requirements were higher in the re-exploration group (p < 0.01). Patients in the re-exploration group had significantly higher incidences of postoperative acute renal injury (10.0 vs. 3.3%), sternal wound (9.1 vs. 2.4%) and pulmonary (13.4 vs. 4.3%) infections, longer ventilation time (22 [range, 14-52] vs. 12 [range, 9-16] hours) and intensive care unit stay (5 [range, 3-7] vs. 2 [range, 2-4] days), and higher mortality rate (9.6 vs. 3.3%). However, the multivariate logistic regression analysis demonstrated that not the re-exploration itself, but the deleterious effects of re-exploration (blood loss and transfusion requirement) were independent risk factors for mortality. Mortality was 5.3% for patients who were re-explored within the first 12 hours and 20.3% for patients who were re-explored after 12 hours (p = 0.003). Mortality was 3.6% for patients with bleeding and 31.4% for patients with cardiac tamponade for indication of re-exploration (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests that re-exploration after cardiac surgery is associated with increased mortality and morbidity. Patients with delayed re-exploration and suffering from cardiac tamponade have adverse outcome.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kolat
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Marietta von
authors.initials: Mv
authors.lastname: Suesskind-Schwendi
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Hirt
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000150:complications / Q000209:etiology*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome