Thorac cardiovasc Surg
DOI: 10.1055/s-0037-1603205
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Low Fibrinogen Is Associated with Increased Bleeding-Related Re-exploration after Cardiac Surgery

Yasin Essa1, Natig Zeynalov1, Tim Sandhaus1, Michael Hofmann2, Thomas Lehmann3, Torsten Doenst1
  • 1Department of Cardiothoracic Surgery, Friedrich Schiller University of Jena, Jena, Germany
  • 2Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
  • 3Institute of Medical Statistics, Computer Sciences and Documentation, Friedrich Schiller University of Jena, Jena, Germany
Further Information

Publication History

13 November 2016

10 April 2017

Publication Date:
16 May 2017 (eFirst)

Abstract

Background Re-exploration after cardiac surgery remains a relatively frequent complication associated with adverse effects on outcome. We aimed to identify risk factors for re-exploration.

Methods We retrospectively reviewed 2,403 patients having undergone cardiac surgical procedure between January 2013 and December 2014. Re-exploration was required in 114 patients (4.7%). Patients with oral anticoagulation, infective endocarditis, or a clearly identified bleeding source were excluded. Therefore, 42 patients remained for analysis. A matched cohort was selected for age, sex, ejection fraction, creatinine, and procedure out of the non–re-explored patients.

Results Demographic data were similar in both groups, except for a higher prevalence of diabetes (45 vs. 21%; p = 0.036) in the non–re-explored patients. Surgery was elective in two-thirds and preoperative plasma fibrinogen concentration was lower in patients requiring re-exploration (2.8 ± 0.9 vs. 3.6 ± 0.9 g/L; p = 0.002). During the initial operation, re-explored patients received more packed red blood cells (1.5 ± 3 vs. 0 ± 1 units; p < 0.001), Postoperatively, re-explored patients had higher lactate levels (1.7 ± 1.4 vs. 1.3 ± 0.6 mmol/L, p = 0.044), more chest tube drainage (1,245 ± 948 vs. 685 ± 413 mL; p < 0.001), higher hospital mortality (19 vs. 7%; p = 0.19), and longer intensive care unit (ICU) stays (8 ± 8 vs. 4 ± 7 days; p = 0.010). In addition, more fibrinogen was administrated during the initial surgery. Plasma fibrinogen concentration upon arrival at the ICU was lower in patients requiring re-exploration (2 ± 0.6 vs. 2.7 ± 0.7 g; p < 0.001). Multivariable linear regression analysis identified fibrinogen upon arrival at the ICU as an independent predictor of postoperative bleeding.

Conclusion Cardiac surgery patients with low perioperative plasma fibrinogen concentration appear to be more susceptible to bleeding and re-exploration. Re-exploration in this group of patients is associated with increased morbidity and mortality.