دورية أكاديمية
أعرض في EDS

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate.

التفاصيل البيبلوغرافية
العنوان: Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate.
المؤلفون: Elassal AA; Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia. samalassal1434@gmail.com.; Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt. samalassal1434@gmail.com., Al-Ebrahim KE; Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia., Debis RS; Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia., Ragab ES; Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt., Faden MS; Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia., Fatani MA; Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia., Allam AR; Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.; Department of Cardiac Surgery, Naser Institute of Research and Treatment, Cairo, Egypt., Abdulla AH; Department of Surgery, Cardiac Surgery Unit, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.; Cardiothoracic Surgery Department, Alahrar Hospital, Zagazig, Egypt., Bukhary AM; Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia., Noaman NA; Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia., Eldib OS; Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt.
المصدر: Journal of cardiothoracic surgery [J Cardiothorac Surg] 2021 Jun 07; Vol. 16 (1), pp. 166. Date of Electronic Publication: 2021 Jun 07.
نوع المنشور: Journal Article; Observational Study
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BioMed Central, 2006-
مواضيع طبية MeSH: Algorithms* , Cardiac Surgical Procedures* , Checklist*, Hemostasis, Surgical/*standards , Perioperative Care/*standards , Postoperative Hemorrhage/*diagnosis , Postoperative Hemorrhage/*surgery, Adult ; Aged ; Female ; Follow-Up Studies ; Hemostasis, Surgical/methods ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Perioperative Care/methods ; Postoperative Hemorrhage/epidemiology ; Postoperative Hemorrhage/prevention & control ; Reoperation ; Retrospective Studies ; Risk Factors
مستخلص: Background: Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons.
Objective: To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management.
Methods: Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome.
Results: Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality.
Conclusion: Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.
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معلومات مُعتمدة: DF- 729 - 140 - 1441 King Abdulaziz University
فهرسة مساهمة: Keywords: Bleeding; Cardiac surgery; Re-exploration
تواريخ الأحداث: Date Created: 20210608 Date Completed: 20210707 Latest Revision: 20210707
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC8183590
DOI: 10.1186/s13019-021-01545-4
PMID: 34099003
قاعدة البيانات: MEDLINE
الوصف
تدمد:1749-8090
DOI:10.1186/s13019-021-01545-4