• Sandeep P Tambe, Hans-Henrik Kimose, Raben GreisenJacobJDepartment of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark., and Carl-Johan Jakobsen.
• Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
• Interact Cardiovasc Thorac Surg. 2017 Aug 1; 25 (2): 233-240.

ObjectivesIn cardiac surgery, postoperative bleeding remains a frequent complication with various possible adverse outcomes. Re-exploration due to bleeding is frequent in this type of patient. Sternal wound infection is an infrequent but serious and devastating complication. Whether re-exploration due to bleeding significantly affects the incidence of sternal wound infection is uncertain. There is no consensus on allowed severity of bleeding and timing of intervention.MethodsA retrospective, observational cohort study of 15 350 consecutive patients who underwent cardiac surgical procedures from 1 April 2006 through 31 December 2013 in 3 different university hospitals in Denmark was performed. Re-exploration due to postoperative bleeding occurred in 873 patients. To adjust for possible confounders, propensity score matching and logistic regression analyses were performed based on the centre, EuroSCORE I/II factors, extracorporeal circulation time, drugs affecting bleeding and coagulation, postoperative bleeding and units of blood transfusions. Patients were matched into 2 groups of 779 patients each for further analysis. The short-term outcomes were sternum infection, 30-day mortality and acute renal failure needing dialysis. The long-term outcome was the number of deaths 6 months after surgery.ResultsThe incidence of re-exploration was 5.7%. In the raw data, sternal infection was higher in the re-exploration group (2.4% vs 1.4; P = 0.020). After propensity score matching, no differences in sternal infection or other measured outcomes were found between the groups, either by crude or adjusted analyses.ConclusionsOur study indicates that re-exploration is not associated with a higher frequency of severe postoperative complications. Probably the time of intervention for bleeding is important.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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