• Fausto Biancari, Reija Mikkola, Jouni Heikkinen, Jarmo Lahtinen, K E Juhani Airaksinen, and Tatu Juvonen.
• Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
• Eur J Cardiothorac Surg. 2012 Jan 1;41(1):50-5.

ObjectiveThe aim of this study was to evaluate the impact of re-exploration for bleeding after cardiac surgery on the immediate postoperative outcome.MethodsSystematic review of the literature and meta-analysis of data on re-exploration for bleeding after adult cardiac surgery were performed.ResultsThe literature search yielded eight observational studies reporting on 557,923 patients and were included in the present analysis. Patients requiring re-exploration were significantly older, more frequently males, had a higher prevalence of peripheral vascular disease and preoperative exposure to aspirin, and more frequently underwent urgent/emergency surgery. Re-exploration was associated with significantly increased risk ratio (RR) of immediate postoperative mortality (RR 3.27, 95% confidence interval (CI) 2.44-4.37), stroke, need of intra-aortic balloon pump, acute renal failure, sternal wound infection, and prolonged mechanical ventilation. The pooled analysis of four studies (two being propensity score-matched pairs analysis) reporting adjusted risk for mortality led to an RR of 2.56 (95%CI 1.46-4.50). Studies published during the last decade tended to report a higher risk of re-exploration-related mortality (RR 4.30, 95%CI 3.09-5.97) than those published in the 1990s (RR 2.75, 95%CI 2.06-3.66).ConclusionsThis study suggests that re-exploration for bleeding after cardiac surgery carries a significantly increased risk of postoperative mortality and morbidity.

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