“FREQUENCY OF RE-EXPLORATION DUE TO EXCESSIVE BLEEDING AND ITS RELATION TO BODY MASS INDEX IN POST-OPERATIVE CORONARY ARTERY BYPASS GRAFTING AT A TERTIARY CARE HOSPITAL KARACHI”

Main Article Content

Dr. Commando Talreja
Dr Hammad Hassan
Dr Aamir Ali Kalhoro
Dr Tousif Ahmed
Dr Karan Kumar
Dr Mohammad Ali Naper
Dr Vinay Kumar Gemnani

Keywords

Bleeding, Body Mass Index, CABG, Re-exploration

Abstract

Objectives: To determine the frequency of re-exploration due to excessive bleeding in post-operative coronary artery bypass graft patients at a tertiary care hospital in Karachi.


To compare the frequency of re-exploration with body mass index in postoperative coronary artery bypass graft patients at a tertiary care hospital in Karachi


Study design and setting: A descriptive cross-sectional study was carried out at the Cardiac Surgery Unit, NICVD, Karachi, Pakistan, during the period Oct: 2022 to Dec 2023.


Materials and Methods: All participants who fulfilled the inclusion criteria and attended NICVD, Karachi, were included in the study. After outlining the protocol, risks, and advantages of the study, informed written consent was attained. All patient in our study was sent to a specialized intensive care unit (ICU). and kept under close observation during their post-surgery hospital stay, and re-exploration due to bleeding was recorded. Data was collected in Proform, and the SPSS-18 version was applied for analysis.


Results: Patients' ages varied from 30 to 70 years old, with a median age of 55. In the distribution of gender, 151 (75.1%) were male, while 50 (24.9%) were female. Re-exploration was found in 8 (4%) patients, whereas in comparison, re-exploration was noted in 5 (2.5%) vs. 3 (1.5%) patients between body mass index 19--30 vs. >30 kg/m2 patients, with a non-significant P-value (P = 0.432).


Conclusion: In conclusion, the low rate of re-exploration was noted due to excessive bleeding in post-operative coronary artery bypass surgery.


Patients with non-significant differences in body mass index. It is advised that further extensive research be done to validate the present findings.

Abstract 28 | PDF Downloads 11

References

1. MellyL, TorregrossaG,LeeT,Jansens JL,PuskasJD.Fiftyyearsof coronaryartery bypass grafting. J Thorac Dis. 2018;10(3):1960-7.
2. Suo Z, Yang Y, Zhang J, editors. The actual cause of gender difference after coronary artery bypass grafting. E3S Web of Conferences; 2021: EDP Sciences.
3. JawitzOK,GulackBC,BrennanJM,ThibaultDP,WangA,O'BrienSM,etal.Associationof postoperative complications and outcomes following coronary artery bypass grafting. Am Heart J. 2020;222:220-8.
4. Biancari F, Ruggieri VG, Perrotti A, Svenarud P, Dalen M, Onorati F, et al. European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG registry): Study Protocol for a prospective clinical registry and proposal of classification of postoperative complications. J Cardiothorac Surg. 2015;10(1):90.
5. Dimberg A, Alstrom U, Janiec M. Re-exploration for bleeding associated with increased incidence of the need for reintervention after coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg. 2019;28(2):214-21.
6. Heidari A, Firoozabadi MD, Sheikhi MA. Postoperative bleeding in CABG patients: new study in southwest of Iran. Age. 2016;57:8.70.
7. Marteinsson SA, Heimisdottir AA, Axelsson TA, Johannesdottir H, Arnadottir LO, Gardarsdottir HR, et al. Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes. Scand Cardiovasc J. 2020;54(4):265- 73.
8. ul Islam M, Ahmad I, Bahauddin Khan AJ, Ali N, Khan WH, Farooq O, et al. Early chest re- exploration for excessive bleeding in post cardiac surgery patients: does it matter? Cureus. 2021;13(5).
9. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004;78(2):527-34.
10. Tambe SP, Kimose HH, Raben Greisen J, Jakobsen CJ. Re-exploration due to bleeding is not associated with severe postoperative complications. Interact Cardiovasc ThoracSurg. 2017;25(2):233-40.
11. Wang M, Chen M, Ao H, Chen S, Wang Z. The effects of different BMI on blood loss and transfusionsinChinese patients undergoingcoronary artery bypassgrafting.AnnThorac Cardiovascul Surg. 2017;23(2):83-90.
12. Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;14(6):709-13.
13. Coronary artery bypass surgery 2016 [cited 2021 November 25]. Available from: https://en.wikipedia.org/wiki/Coronary artery_bypass surgery.
14. Yazdchi F, Rawn JD. Postoperative Care of Cardiac Surgery Patients. In: Cohn LH, Adams DH, editors. Cardiac Surgery in the Adult, 5e. New York, NY: McGraw-Hill Education; 2017.
15. Dacey LJ, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, et al. Reexplorationfor hemorrhage following coronary artery bypass grafting: incidence and risk factors. Arch Surg. 1998;133(4):442-7.
16. Unsworth-White MJ, Herriot A, Valencia O, Poloniecki J, Smith EJ, et al. Resternotomyfor bleeding after cardiac operation: a marker for increased morbidity and mortality.Ann Thorac Surg. 1995;59(3):664-7.
17. Sellman M, Intonti MA, Ivert T. Reoperations for bleeding after coronary artery bypass procedures during 25 years. Eur J Cardiothorac Surg 1997;11:521–7.
18. Lu J, Grayson AD, Jha P, Srinivasan AK, Fabri BM. Riskfactors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 2003;23:943–9.
19. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Re-exploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996;111:1037–46.
20. Despotis GJ, Filos KS, Zoys TN, Hogue CW Jr, Spitznagel E, Lappas DG. Factors associated with excessive postoperative blood loss and haemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients. Anaesth Analg 1996;82:13–21.
21. Dyke C, Aronson S, DietrichW, Hofmann A, Karkouti K, Levi M, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147 (5):1458-63.
22. Fröjd V, Jeppsson A: Reexploration for bleeding and its association with mortality after cardiac surgery . Ann Thorac Surg. 2016;102:109-17.
23. Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G: Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery . Ann Thorac Surg. 2013;96:478-85.
24. Vivacqua A, Koch CG, Yousuf AM, Nowicki ER, Houghtaling PL, Blackstone EH, et al: Morbidity of bleeding after cardiac surgery: is it blood transfusion, reoperation for bleeding, or both? Ann Thorac Surg. 2011;91:1780-90.
25. Kremke M, Tang M, Bak M, Kristensen KL, Hindsholm K, Andreasen JJ, et al. Antiplatelet therapy at the time of coronary artery bypass grafting: a multicentre cohort study. Eur J Cardiothorac Surg. 2013;44(2):e133-40.
26. Jakobsen CJ, Ryhammer PK, Tang M, Andreasen JJ, Mortensen PE: Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients. Eur J Cardiothorac Surg. 2012;42:114-20.
27. Kremke M, Hansen MK, Christensen S, Tang M, Andreasen JJ, Jakobsen CJ. The association between platelet transfusion and adverse outcomes after coronary artery bypass surgery. Eur J Cardiothorac Surg. 2015;48:102-9.
28. Choong CK, Gerrard C, Goldsmith KA, Dunningham H, Vuylsteke A. Delayed re- exploration for bleeding after coronary artery bypass surgery results in adverse outcomes. Eur J Cardiothorac Surg. 2007;31:834-8.
29. Karkouti K, Callum J, Wijeysundera DN, Rao V, Crowther M, Grocott HP, et al. Point-of- care hemostatic testing in cardiac surgery: a stepped-wedge clustered randomized controlled trial. Circulation. 2016;134(16):1152-62.
30. Janiec M, Nazari Shafti TZ, Dimberg A, Lagerqvist B, Lindblom RPF: Graft failure and recurrenceofsymptomsafter coronary arterybypassgrafting. Scand CardiovascJ. 2018, 52:113-9.
31. Nagachinta T, Stephens M, Reitz B, Polk BF. Risk factors for surgical wound infection following cardiac surgery. J Infect Dis 1987;156:967–73.
32. Milano A, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary artery bypass graft surgery-risk factors and long-term survival. Circulation 1995;92:2245–51.
33. Awad WI, De Souza AC, Magee PG, Walesby RK, Wright JE, Uppal R. Redo cardiacsurgery in patients over 70 years old. Eur J Cardiothorac Surg 1997;12:40–6.
34. Morales D, Williams E, John R. Is resternotomy in cardiac surgery still a problem? Interact CardioVasc Thorac Surg 2010;11:277–86.
35. Kuralay E, Bolcal C, Cingoz F, Gunay C, Yildirim V, Kilic S et al. Cardiac reoperation by Carpentier bicaval femoralvenouscannula: GATAexperience. Ann Thorac Surg 2004;77: 977–82.
36. Elahi MM, Dhannapuneni R, Firmin R, Hickey M. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc Thorac Ann 2005;13:135–8.
37. Biancari F, Airaksinen KEJ,LipGY. Benefits and risks of using clopidogrel before coronary artery bypass surgery: systematic review and meta-analysis of randomized trials and observational studies. J Thorac Cardiovasc Surg 2011; in press.
38. Koster A, Schirmer U. Re-evaluation of the role of antifibrinolytic therapy with lysine analogs during cardiac surgery in the post aprotinin era. Curr Opin Anaesthesiol 2010; 24:92–7.
39. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg 2004;78:527–34.
40. Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A. Surgical reexploration after cardiac operations: why a worse outcome? Ann Thorac Surg 2008;86:1557–62.
41. Mehta RH, Sheng S, O’Brien SM, Grover FL, Gammie JS, Ferguson TB. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes 2009;2:583–90.

Most read articles by the same author(s)