Planned Versus Unplanned Reexplorations for Bleeding: A Comparison of Morbidity and Mortality

Friday, September 23, 2016

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Source

Source Name: Annals of Thoracic Surgery

Source URL: http://www.annalsthoracicsurgery.org/article/S0003-4975(16)30859-1/abstract

Author(s)

Todd C. Crawford, MD, J. Trent Magruder, MD, Joshua C. Grimm, MD, Christopher M. Sciortino, MD, Kaushik Mandal, MD, Kenton J. Zehr, MD, Duke E. Cameron, MD, Glenn J. Whitman, MD, John V. Conte, MD

The Johns Hopkins group reviewed their experience with mediastinal exploration for bleeding after cardiac surgery during the period from 2011 through June 2014, and retrospectively reviewed the outcomes of two categories of patients: (1) Planned Reexploration, defined as patients left open at the initial operation with a plan for a second-look procedure (n=62), and (2) Unplanned Reexploration, defined as those patients who initially underwent sternal closure but required reexploration for bleeding (n=48). Propensity matching generated 30 well-matched pairs for comparison. The primary outcome, operative mortality, was no different between the planned and unplanned reexploration groups, whether propensity-matched (37% v. 37%, p=.47) or not (29% v. 23%, p=.47). The authors conclude that delayed sternal closure with planned reexploration is a safe alternative to initial sternal closure in patients at increased risk for ongoing bleeding.

Comment: After reading this study, would you have a lower threshold for leaving a chest open for bleeding upon completion of a cardiac operation? Why or why not?

Comments

Submitted by Leo Fitzgibbon on Fri, 2016-09-23 19:39

In 25 years of adult cardiac surgery, I have found that delayed primary closure of sternotomy is appropriate in complex cases involving prolonged periods of profound hypothermia and multiple valve redo operations. Thanks, one surgeons experience

Submitted by Leo Fitzgibbon on Fri, 2016-09-23 19:39

Submitted by Ghassan Musleh on Sat, 2016-09-24 04:26

Yes, after reading this article I will have a lower threshold to delay the primary closure. The causes of bleeding in the unplanned re exploration in general cardiac surgey practice are either coagulopathy (expected to bleed ) or due to a surgical cause (not expected to bleed). After this article ,I will not be very concerned about delaying primary closure in those with coaggulopathy.