{"title":"Impact of surgical re-exploration on 30-day mortality for post-operative bleeding in off-pump coronary artery bypass grafting.","authors":"Sufina Shales, Hari Govind Varma, Paramita Auddya Ghorai, Rahul Mahanty, Subhendu Adhikari, Tanulina Sarkar, Debasis Das, Pradeep Narayan","doi":"10.1007/s12055-025-01966-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This retrospective cohort study aimed to investigate the incidence, predictors, and outcomes of surgical re-exploration for postoperative bleeding in patients undergoing elective, isolated off-pump coronary artery bypass grafting (OPCAB).</p><p><strong>Methods: </strong>Patients undergoing elective isolated OPCAB were included in the study. Patients were categorized into two groups: those requiring re-exploration for postoperative bleeding and those not requiring re-exploration. Demographic, clinical, and operative variables were compared. Multivariable logistic regression was used to identify independent risk factors for re-exploration and 30-day mortality.</p><p><strong>Results: </strong>Out of the 4,957 eligible patients, 178 (3.6%) required surgical re-exploration for postoperative bleeding. Patients undergoing re-exploration were significantly older (61.4 ± 7.25 years vs. 58.75 ± 8.97 years, <i>p</i> < 0.0001) and had a lower proportion of females (7.3% vs. 13.8%, <i>p</i> = 0.013). Independent risk factors for re-exploration included age [OR (Odds Ratio) 1.022; 95% Confidence Interval(CI): 1.002-1.042, <i>p</i> = 0.030)], Society of Thoracic Surgeons (STS) Score (OR 1.166; 95% CI: 1.054-1.289, <i>p</i> = 0.003), 24-h drainage volume OR 1.004; 95% CI: 1.003-1.004, <i>p</i> < 0.000), and Left ventricular ejection fraction < 40% (OR 1.49; 95%CI: 1.024-2.167, <i>p</i> = 0.037). Re-exploration for postoperative bleeding was associated with significantly higher rates of blood transfusion, respiratory complications, renal failure, and mechanical ventilation. The 30-day mortality was substantially higher in the re-exploration group (8.4% vs. 0.8%, <i>p</i> < 0.0001). Multivariable analysis revealed that re-exploration for postoperative bleeding was the most profound independent factor for 30-day mortality (OR 11.51; 95% CI: 5.861-22.616, p < 0.001).</p><p><strong>Conclusions: </strong>Re-exploration is not just a surgical technical event, but a critical turning point that dramatically alters patient outcome. It is, therefore, paramount to identify high-risk patients and develop strategies to reduce bleeding complications and re-explorations in order to improve patient outcomes.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01966-z.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1387-1395"},"PeriodicalIF":0.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450167/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-01966-z","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/19 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: This retrospective cohort study aimed to investigate the incidence, predictors, and outcomes of surgical re-exploration for postoperative bleeding in patients undergoing elective, isolated off-pump coronary artery bypass grafting (OPCAB).
Methods: Patients undergoing elective isolated OPCAB were included in the study. Patients were categorized into two groups: those requiring re-exploration for postoperative bleeding and those not requiring re-exploration. Demographic, clinical, and operative variables were compared. Multivariable logistic regression was used to identify independent risk factors for re-exploration and 30-day mortality.
Results: Out of the 4,957 eligible patients, 178 (3.6%) required surgical re-exploration for postoperative bleeding. Patients undergoing re-exploration were significantly older (61.4 ± 7.25 years vs. 58.75 ± 8.97 years, p < 0.0001) and had a lower proportion of females (7.3% vs. 13.8%, p = 0.013). Independent risk factors for re-exploration included age [OR (Odds Ratio) 1.022; 95% Confidence Interval(CI): 1.002-1.042, p = 0.030)], Society of Thoracic Surgeons (STS) Score (OR 1.166; 95% CI: 1.054-1.289, p = 0.003), 24-h drainage volume OR 1.004; 95% CI: 1.003-1.004, p < 0.000), and Left ventricular ejection fraction < 40% (OR 1.49; 95%CI: 1.024-2.167, p = 0.037). Re-exploration for postoperative bleeding was associated with significantly higher rates of blood transfusion, respiratory complications, renal failure, and mechanical ventilation. The 30-day mortality was substantially higher in the re-exploration group (8.4% vs. 0.8%, p < 0.0001). Multivariable analysis revealed that re-exploration for postoperative bleeding was the most profound independent factor for 30-day mortality (OR 11.51; 95% CI: 5.861-22.616, p < 0.001).
Conclusions: Re-exploration is not just a surgical technical event, but a critical turning point that dramatically alters patient outcome. It is, therefore, paramount to identify high-risk patients and develop strategies to reduce bleeding complications and re-explorations in order to improve patient outcomes.
Graphical abstract:
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01966-z.
目的：本回顾性队列研究旨在探讨择期孤立非体外循环冠状动脉旁路移植术（OPCAB）患者术后再探查出血的发生率、预测因素和结果。方法：择期孤立性OPCAB患者纳入研究。患者分为两组：需要再次探查术后出血的患者和不需要再次探查的患者。比较人口学、临床和手术变量。采用多变量logistic回归确定再探索和30天死亡率的独立危险因素。结果：在4957例符合条件的患者中，178例（3.6%）因术后出血需要再次手术探查。再次探查的患者明显更老（61.4±7.25岁vs 58.75±8.97岁，p p = 0.013）。再探查的独立危险因素包括年龄[OR（比值比）1.022；95%可信区间（CI）： 1.002-1.042, p = 0.030)]，胸外科学会（STS）评分（OR 1.166; 95% CI: 1.054-1.289, p = 0.003）， 24小时引流量OR 1.004；95% CI: 1.003-1.004, p = 0.037)。术后再次探查出血与输血、呼吸系统并发症、肾功能衰竭和机械通气的发生率显著升高相关。再次探查组的30天死亡率明显更高（8.4% vs. 0.8%）。结论：再次探查不仅仅是一个外科技术事件，而且是一个显著改变患者预后的关键转折点。因此，识别高危患者并制定策略以减少出血并发症和再探查以改善患者预后是至关重要的。图片摘要：补充资料：在线版本包含补充资料，可在10.1007/s12055-025-01966-z获得。
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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