In-hospital and mid-term outcomes in patients reoperated on due to bleeding following coronary artery surgery (from the KROK Registry)
Authors: Knapik Piotr , Knapik Małgorzata , Zembala Michał O , Przybyłowski Piotr , Nadziakiewicz Paweł , Hrapkowicz Tomasz , Cieśla Daniel , Deja Marek , Suwalski Piotr , Jasiński Marek , Tobota Zdzisław , Maruszewski Bohdan J , Zembala Marian ,   KROK Investigators, Anisimowicz Lech , Biederman Andrzej , Borkowski Dariusz , Brykczyński Mirosław , Bugajski Paweł , Cholewiński Paweł , Cichoń Romuald , Cisowski Marek , Deja Marek , Dziatkowiak Antoni , Gryszko Leszek A , Gburek Tadeusz , Haponiuk Ireneusz , Hendzel Piotr , Hirnle Tomasz , Jabłonka Stanisław , Jarmoszewicz Krzysztof , Jasiński Marek , Jaszewski Ryszard , Jemielity Marek , Kalawski Ryszard , Kapelak Bogusław , Kaperczak Jacek , Karolczak Maciej A , Krejca Michał , Kustrzycki Wojciech , Kuśmierczyk Mariusz , Kwinecki Paweł , Maruszewski Bohdan , Missima Maurycy , Ogorzeja Jacek J Moll Wojciech , Pająk Jacek , Pawliszak Wojciech , Pietrzyk Edward , Religa Grzegorz , Rogowski Jan , Różański Jacek , Sadowski Jerzy , Sharma Girish , Skalski Janusz , Skiba Jacek , Stążka Janusz , Stępiński Piotr , Suwalski Kazimierz , Suwalski Piotr , Tobota Zdzisław , Tułecki Łukasz , Widenka Kazimierz , Wojtalik Michał , Woś Stanisław , Zembala Marian , Żelazny Piotr 
Published: March 2019

Abstract

OBJECTIVES
Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data.

METHODS
We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60–70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge.

RESULTS
Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications.

CONCLUSIONS
Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.