Objective

Reopening immediately post cardiac surgery is a problematic complication. Studies suggest re exploration for bleeding and/or tamponade significantly affect in hospital mortality and length of stay in cardiac intensive care unit (CICU). We compared the short and long term outcomes of patients who were reopened (RE) following cardiac surgery with those who were not reopened (control) using Propensity Score Matching (PSM).

Methods

This was a retrospective study of data entered prospectively into our cardiac surgical database between April 2004 and September 2015. In total, 7960 patients underwent cardiac surgery. Of these 539 (6.8%) were reopened immediately post cardiac surgery for either bleeding, tamponade or dysrhythmia. PSM (baseline characteristics, pre operative variables including EF, EuroSCORES, logistic EuroSCORES and type of cardiac operation) produced 509 RE versus 509 control groups.

Results

The 30 day mortality in RE group was 22% versus 3.9% in control group (p<0.0001). Long term survival at 11 years follow up was 63.5% in RE vs 81.5% in control group (Log Rank < 0.0001). Patients discharged alive had a comparable long term survival 82.4% in RE versus 84.9% in control groups (Log Rank = 0.396). Multivariate analysis revealed that preop ionotropes, IABP, renal disease, longer cross clamp and bypass times were the significant (p<0.005) determinants of reopening post cardiac surgery.

Conclusion

We have shown that whilst reopening post cardiac surgery carries a high short term mortality, the long term mortality is not significantly greater in those who survive to discharge.