Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

Mujahid Ul Islam; Imtiaz Ahmad; Bahauddin Khan; Azam Jan; Niaz Ali; Waasay Hassan Khan; Omer Farooq; Hooria Khan; Faizan Ahmad Ali; Muhammad Shahid

doi:10.7759/cureus.15091

Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

Cureus. 2021 May 18;13(5):e15091. doi: 10.7759/cureus.15091.

Authors

Affiliations

¹ Anesthesiology, Rehman Medical Institute, Peshawar, PAK.
² Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK.
³ Cardiac Surgery, Northwest School of Medicine, Peshawar, PAK.
⁴ Radiology, Hayatabad Medical Complex, Peshawar, PAK.

Abstract

Introduction Re-explorations after open-heart surgery are often required if the patient is bleeding or shows features of cardiovascular instability and does not improve with conservative measures. Our study aims to determine whether timely re-exploration of patients who are bleeding has an impact on the morbidity and mortality of the patients. Methods A retrospective analysis of 75 patients that underwent open-heart surgery and subsequently underwent chest re-exploration for excessive bleeding betweenMarch 2018 and March 2020. Patients who were reopened post-op for indications other than excessive bleeding were excluded. Results A total number of cases were 700, out of which 75 (9.3%) patients were reopened, as compared to the literature, which shows worldwide 2-11% being reopened. Post-operative drain output was 1000ml to 1500ml in 47 (62.7%) and more than 1500ml in 28 (37.3%) patients before they were reopened. In 67 (89.3%) patients, three to five units of blood were transfused, and in eight (10.7%) patients, more than five units of blood were transfused. We believe our mortality in the reopened patients was low, because of timely intervention and early re-exploration, and is probably the reason why our figures land in a higher range (2-11%) of reopened cases (9.3%). Reopening time was less than five hours in 49 (65.3%) patients and less than 10 hours in 26 (34.7%) patients in our study. We tried to minimize the loss of blood and re-explored the patients before they lose excessive blood, the average time for reopening in our study was less than 10 hours. The average intensive care unit (ICU) stay was 4.2 days (range three to six days). Wound infections were reported in one of three patients. There was no mortality in these patients. Surgical site of bleeding was identified in 54 (72%) patients and no particular site was found in 21 (28%) patients. Suggesting that it is common to have a surgical bleeder than coagulopathy induced bleeding in post-cardiac surgery patients Conclusions We believe our low mortality (0%) is due to early reopening in patients who are bleeding excessively after cardiac surgery.

Keywords: blood transfusion; chest reopening; coagulopathy; excessive bleeding; surgical bleeding.