In this retrospective study, the data of 14,152 patients who underwent cardiac surgery between 2011 and 2017 at the University of Pittsburgh Medical Center, Pennsylvania, were examined. Cardiac surgeries included in the analysis were: elective, emergent, concomitant valve repair/replacement, and urgent surgeries. A cardiac surgical database was used to collect perioperative data and long-term outcomes. A multivariable Cox regression analysis was performed to identify independent predictors of readmission and mortality 30 days and 1 and 5 years after reoperative surgery.
A total of 1700 patients (12%) had reoperative cardiac surgery. The need for reoperation was found to be an independent predictor of survival at 30 days (hazard ratio [HR], 2.09; 95% CI, 1.38-3.2; P =.0005), 1 year (HR, 1.82; 95% CI, 1.37-2.42; P <.0001], and 5 years (HR, 1.86; 95% CI-1.42-2.43; P <.0001).
Reoperation was the only significant predictor of mortality at 30 days (HR, 1.36; 95% CI, 1.05-1.75; P =.02), 1 year (HR, 1.30; 95% CI, 1.09-1.55; P =.004), and 5 years (HR, 1.30; 95% CI, 1.14-1.5; P =.0002) after propensity matching. Additionally, the occurrence of ≥2 reoperations was an independent predictor of 5-year mortality (HR, 1.33; 95% CI, 1.11-1.73; P =.04).
Reoperative surgery was a significant predictor of 5-year — but not 30-day — readmission (HR, 1.18; 95% CI, 1.00-1.41; P =.04). The occurrence of≥2 reoperations was a predictor of 1-year (HR, 1.31; 95% CI, 1.1-1.67; P =.03) and 5-year (HR, 1.31; 95% CI, 1.06-1.63; P =.01) readmissions.
Limitations of the study include its retrospective design and the heterogeneity of operative procedures, which may limit applicability of the findings to specific operative procedures.
“After correcting for preoperative baseline risk, reoperative surgery remains a significant predictor of both short and long-term mortality. These findings are likely related to increased need for postoperative blood transfusions and prolonged mechanical ventilation in the redo cardiac surgery cohort,” noted the study authors.
Bianco V, Kilic A, Gleason TG, et al. Reoperative cardiac surgery is a risk factor for long-term mortality [published online March 18, 2020]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2020.02.028