REEXPLORATION FOR HEMORRHAGE FOLLOWING CORONARY-ARTERY BYPASS-GRAFTING - INCIDENCE AND RISK-FACTORS

Objective: To assess mortality and risk factors associated with reexpl oration for hemorrhage in patients undergoing coronary artery bypass g rafting (CABG). Design: Regional cohort study. Patient characteristics , treatment variables, and outcome measures were collected prospective ly. Setting: All 5 centers performing cardiac surgery in Maine, New Ha mpshire, and Vermont. Patients: A consecutive cohort of 8586 patients undergoing isolated CABG between 1992 and 1995. Main Outcome Measures: Postoperative hemorrhage leading to reexploration, in-hospital mortal ity, and length of stay. Results: A total of 305 patients (3.6%) under went reexploration for bleeding. In these patients, in-hospital mortal ity was nearly 3 times higher (9.5% vs 3.3% for patients not requiring reoperation, P<.001) and average length of stay from surgery to disch arge was significantly longer (14.5 days vs 8.6 days, P<.001). High ra tes of reexploration for hemorrhage were observed in patients with pro longed (>150 minutes) cardiopulmonary bypass (39 [11.1%] of 351) and i n those requiring an intra-aortic balloon pump intraoperatively (12 [8 %] of 139). In multivariate analysis, older age, smaller body surface area, prolonged cardiopulmonary bypass, and number of distal anastomos es were associated with increased bleeding risks. The use of thromboly tic therapy within 48 hours of surgery was weakly but not significantl y associated with the need for reexploration. Factors not sig nificant ly associated with reexploration included patient sex, preoperative ej ection fraction, surgical priority, history of liver disease, myocardi al infarction, prior CABG, renal failure, and diabetes mellitus. Concl usions: hemorrhage requiring reexploration after CABG is associated wi th markedly increased mortality and length of stay. Patients predicted to have increased risks of bleeding may benefit from prophylactic use of aprotinin, aminocaproic acid, or other agents shown to reduce hemo rrhage.