Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons
Surgical re-explorations represent 3–5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (O...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/19/4288 |
| _version_ | 1797516171892752384 |
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| author | Alessandro Affronti Elena Sandoval Anna Muro Jose Hernández-Campo Eduard Quintana Daniel Pereda Jorge Alcocer Robert Pruna-Guillen Manuel Castellà |
| author_facet | Alessandro Affronti Elena Sandoval Anna Muro Jose Hernández-Campo Eduard Quintana Daniel Pereda Jorge Alcocer Robert Pruna-Guillen Manuel Castellà |
| author_sort | Alessandro Affronti |
| collection | DOAJ |
| description | Surgical re-explorations represent 3–5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR). Single center retrospective review of patients who underwent mediastinal re-exploration in the ICU or in the OR after cardiac surgery. Mediastinal re-explorations were also classified as: “planned” and “unplanned”. Primary outcome was 30-day mortality, secondary outcomes include deep sternal wound infection (DSWI), sepsis, ICU and hospital length of stay, prolonged intubation (>72 h), tracheostomy, pneumonia, acute kidney injury requiring dialysis and stroke. Between 2010 and 2019, 195 of 7263 patients (2.7%) underwent mediastinal re-exploration after cardiac surgery. More patients in the ICU group experienced two or more re-explorations (30.3% vs. 2.3%, <i>p</i> < 0.001), a higher incidence of postoperative pneumonia (22% vs. 7%, <i>p</i> = 0.004), prolonged intubation (46.8% vs. 19.8%, <i>p</i> < 0.001) and longer hospital stay (30.3 ± 34.2 vs. 20.8 ± 18.3 days, <i>p</i> = 0.014). There were no differences in mortality between ICU and OR (16.5% vs. 13.9%, <i>p</i> = 0.24) nor in sepsis (14.7% vs. 7%, <i>p</i> = 0.91) and DSWI rates (1.8% vs. 1.2%, <i>p</i> = 0.14). Re-explorations in the ICU were not associated with increased mortality, sepsis and mediastinitis rate. |
| first_indexed | 2024-03-10T06:57:32Z |
| format | Article |
| id | doaj.art-03d1c4d282e145c294e3260d9cc71500 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:57:32Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-03d1c4d282e145c294e3260d9cc715002023-11-22T16:17:11ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011019428810.3390/jcm10194288Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by SurgeonsAlessandro Affronti0Elena Sandoval1Anna Muro2Jose Hernández-Campo3Eduard Quintana4Daniel Pereda5Jorge Alcocer6Robert Pruna-Guillen7Manuel Castellà8Cardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainCardiovascular Surgery, Hospital Clínic, University of Barcelona, c/Villarroel 170 Esc 1 5th Floor, 08036 Barcelona, SpainSurgical re-explorations represent 3–5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR). Single center retrospective review of patients who underwent mediastinal re-exploration in the ICU or in the OR after cardiac surgery. Mediastinal re-explorations were also classified as: “planned” and “unplanned”. Primary outcome was 30-day mortality, secondary outcomes include deep sternal wound infection (DSWI), sepsis, ICU and hospital length of stay, prolonged intubation (>72 h), tracheostomy, pneumonia, acute kidney injury requiring dialysis and stroke. Between 2010 and 2019, 195 of 7263 patients (2.7%) underwent mediastinal re-exploration after cardiac surgery. More patients in the ICU group experienced two or more re-explorations (30.3% vs. 2.3%, <i>p</i> < 0.001), a higher incidence of postoperative pneumonia (22% vs. 7%, <i>p</i> = 0.004), prolonged intubation (46.8% vs. 19.8%, <i>p</i> < 0.001) and longer hospital stay (30.3 ± 34.2 vs. 20.8 ± 18.3 days, <i>p</i> = 0.014). There were no differences in mortality between ICU and OR (16.5% vs. 13.9%, <i>p</i> = 0.24) nor in sepsis (14.7% vs. 7%, <i>p</i> = 0.91) and DSWI rates (1.8% vs. 1.2%, <i>p</i> = 0.14). Re-explorations in the ICU were not associated with increased mortality, sepsis and mediastinitis rate.https://www.mdpi.com/2077-0383/10/19/4288postoperative managementintensive care unitsurgical re-explorationsmediastinitis |
| spellingShingle | Alessandro Affronti Elena Sandoval Anna Muro Jose Hernández-Campo Eduard Quintana Daniel Pereda Jorge Alcocer Robert Pruna-Guillen Manuel Castellà Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons Journal of Clinical Medicine postoperative management intensive care unit surgical re-explorations mediastinitis |
| title | Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons |
| title_full | Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons |
| title_fullStr | Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons |
| title_full_unstemmed | Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons |
| title_short | Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons |
| title_sort | impact of bedside re explorations in a cardiovascular surgery intensive care unit led by surgeons |
| topic | postoperative management intensive care unit surgical re-explorations mediastinitis |
| url | https://www.mdpi.com/2077-0383/10/19/4288 |
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