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Objectives <p>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> Methods <p>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> Results <p>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> &lt; 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> &lt; 0.000), and Left ventricular ejection fraction &lt; 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> &lt; 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 &lt; 0.001).</p> Conclusions <p>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> Graphical Abstract <p></p>

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Impact of surgical re-exploration on 30-day mortality for post-operative bleeding in off-pump coronary artery bypass grafting

  • 期刊论文

  • 发表日期：

    2025年6月19日

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  • Sufina Shales,
  • Hari Govind Varma,
  • Paramita Auddya Ghorai,
  • Rahul Mahanty,
  • Subhendu Adhikari,
  • Tanulina Sarkar,
  • Debasis Das,
  • Pradeep Narayan

摘要

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