Incidence, indications, and risk factors of reopening after cardiac surgery in a tertiary cardiac centre, Sudan: Retrospective observational study

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Fatimah Azhari Gasmalla Gadeltayeb
Elfatih M. Malik
Elamin E. Elnur

Abstract

ABSTRACT


Background Chest re-opening  after  cardiac  surgery  is  a  surgical  approach  that  is  performed  for diagnosing and managing some postoperative complications. The rate of reopening of patients undergoing cardiac surgery varies between 2% to 6%. The most frequent indication for reopening is bleeding after surgery, cardiac tamponade, cardiac arrest and redo surgery. Several risk factors have been associated with reopening including age, sex, body mass index (BMI), New York Heart Association NYHA class, diabetes mellitus, cardiopulmonary bypass and aortic cross clamp time. The aim of this study is to determine the incidence, indications, and risk factors of reopening after cardiac surgery.


 


Methods In this retrospective observational study, a total of consecutive 638 patients who underwent cardiac surgery in Ahmed Gasim cardiac centre in 2017 were included.


 


Results Thirty-nine out of the 638 surgeries done were reopened. The incidence of reopening was 61 per 1000 in all age groups: 90 per 1000 in adults, and 34 per 1000 in paediatrics. Among the 39 reopening cases, bleeding was the most frequent indication for reopening. Multivariate analysis by logistic regression revealed that having NYHA class II gave odds ratio    (OR) = 24.767 (95% confidence interval (CI) =


1.048 – 585.3), previous cardiac surgery OR = 13.9 (95% CI = 1.013 –  193.3),  having diabetes mellitus


OR = 4.885 (95% CI = 1.251 – 19.056), longer cardiopulmonary bypass time OR = 1.012 (95% CI = 1.00


– 1.024), preoperative aspirin intake OR = 3.528 (95% CI = 1.062 – 11.720), and warfarin therapy OR =


12.790 (95% CI = 1.594 – 102.3).


 


Conclusion In Ahmed Gasim cardiac centre, the incidence of reopening after cardiac surgery was found to be relatively higher than the international records. Reopening was mostly performed for management of postoperative bleeding. Factors associated with increased risk of reopening included: cardiac failure assessed by NYHA classification, previous cardiac surgery, diabetes mellitus; anti-thrombotic therapy and longer bypass time.

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References

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