Incidence and Outcomes of Re-exploration in Adult Cardiac Surgery at a Tertiary Care Hospital

Authors

  • Ashok Pradhan Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Rojina Pokharel Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Prassidha B Kadel Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Krishnaprashad Bashyal Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Prabhat Khakural Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Ravi K Baral Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Anil Bhattarai Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Bhagawan Koirala Department of Cardiothoracic and Vascular Surgery, Maharajgunj Medical Campus, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal

Keywords:

Bleeding, cardiac surgery, emergency surgery, modified Bentall’s procedure, re-exploration

Abstract

Introduction
Postoperative bleeding is a significant complication following cardiac surgery, with a global re-exploration incidence of 2-5%. This study aims to investigate re-exploration rates, risk factors, and outcomes within the unique context of a tertiary care center in Nepal.

Methods

In this retrospective, single-center study, we analyzed all consecutive adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass (CPB) at the Manmohan Cardiothoracic Vascular and Transplant Centre (Nepal) between 2018-2021. Data on demographics, clinical characteristics, operative details, re-exploration, and outcomes were extracted from medical records. Statistical analysis included descriptive statistics, chi-square tests, independent samples t-tests, and logistic regression.

Results
Of 720 patients, 56 (7.8%) required re-exploration for bleeding. Emergency procedures were strongly associated with higher re-exploration (p<0.05). Non-surgical bleeding was the primary cause in 42.9% of cases. Independent risk factors included preoperative deranged LFTs (OR=2.1, 95% CI: 1.2-3.7), elevated creatinine (>1.5 mg/dL, OR= 3.2, 95% CI: 1.8-5.6), prolonged CPB time (>120 min), and substantial transfusion requirements. Modified Bentall's procedures had the highest re-exploration rate (21.4%). Re-explored patients experienced higher AKI rates (87.5%), longer hospitalizations (13.6 vs. 7.2 days, p<0.001), and increased in-hospital mortality confined to emergency cases (1.94%).

Conclusions

Emergency procedures had higher rate of re-exploration. Preoperative deranged LFTs, elevated creatinine, prolonged CPB time, and substantial transfusion requirements were independent risk factors for re-exploration. Re-explored cases experienced higher complication. In-hospital mortality were confined to emergency cases only.

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Published

2023-12-31

How to Cite

Pradhan, A., Pokharel, R., Kadel, P. B., Bashyal, K., Khakural, P., Baral, R. K., Bhattarai, A., & Koirala, B. (2023). Incidence and Outcomes of Re-exploration in Adult Cardiac Surgery at a Tertiary Care Hospital . Journal of Institute of Medicine Nepal, 45(3), 21–24. Retrieved from https://jiomnepal.com.np/index.php/jiomnepal/article/view/243