Planned cardiac reexploration in the intensive care unit is a safe procedure

Damien J. LaPar, James M. Isbell, Daniel P. Mulloy, Matthew L. Stone, John A. Kern, Gorav Ailawadi, Irving L. Kron

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background. Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods. All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results. 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU = 75% and unplanned ICU = 18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p < 0.001) and incurred higher observed mortality (37% vs 6%, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions. Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.

Original languageEnglish (US)
Pages (from-to)1645-1652
Number of pages8
JournalAnnals of Thoracic Surgery
Volume98
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Intensive Care Units
Mortality
Morbidity
Risk Adjustment
Postoperative Hemorrhage
Wound Infection
Operating Rooms
Thorax
Multivariate Analysis
Hemorrhage
Safety

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

LaPar, D. J., Isbell, J. M., Mulloy, D. P., Stone, M. L., Kern, J. A., Ailawadi, G., & Kron, I. L. (2014). Planned cardiac reexploration in the intensive care unit is a safe procedure. Annals of Thoracic Surgery, 98(5), 1645-1652. https://doi.org/10.1016/j.athoracsur.2014.05.090

Planned cardiac reexploration in the intensive care unit is a safe procedure. / LaPar, Damien J.; Isbell, James M.; Mulloy, Daniel P.; Stone, Matthew L.; Kern, John A.; Ailawadi, Gorav; Kron, Irving L.

In: Annals of Thoracic Surgery, Vol. 98, No. 5, 01.01.2014, p. 1645-1652.

Research output: Contribution to journalArticle

LaPar, DJ, Isbell, JM, Mulloy, DP, Stone, ML, Kern, JA, Ailawadi, G & Kron, IL 2014, 'Planned cardiac reexploration in the intensive care unit is a safe procedure', Annals of Thoracic Surgery, vol. 98, no. 5, pp. 1645-1652. https://doi.org/10.1016/j.athoracsur.2014.05.090
LaPar DJ, Isbell JM, Mulloy DP, Stone ML, Kern JA, Ailawadi G et al. Planned cardiac reexploration in the intensive care unit is a safe procedure. Annals of Thoracic Surgery. 2014 Jan 1;98(5):1645-1652. https://doi.org/10.1016/j.athoracsur.2014.05.090
LaPar, Damien J. ; Isbell, James M. ; Mulloy, Daniel P. ; Stone, Matthew L. ; Kern, John A. ; Ailawadi, Gorav ; Kron, Irving L. / Planned cardiac reexploration in the intensive care unit is a safe procedure. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 5. pp. 1645-1652.
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abstract = "Background. Cardiac surgical reexploration is necessary in approximately 5{\%} of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods. All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results. 8,151 total patients underwent cardiac operations, including 267 (3.2{\%}) reexplorations (planned ICU = 75{\%} and unplanned ICU = 18{\%}). Among planned ICU reexplorations, 38{\%} of patients had an identifiable surgical bleeding source, and 60{\%} underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5{\%} vs 3{\%}, p < 0.001) and incurred higher observed mortality (37{\%} vs 6{\%}, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions. Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.",
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AU - LaPar, Damien J.

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AU - Ailawadi, Gorav

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N2 - Background. Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods. All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results. 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU = 75% and unplanned ICU = 18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p < 0.001) and incurred higher observed mortality (37% vs 6%, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions. Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.

AB - Background. Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods. All patients undergoing ICU cardiac reexplorations (2000 to2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results. 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU = 75% and unplanned ICU = 18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p < 0.001) and incurred higher observed mortality (37% vs 6%, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions. Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage.

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