Original articleAdult cardiacPredicting In-Hospital Mortality After Redo Cardiac Operations: Development of a Preoperative Scorecard
Section snippets
Patients
This single-center retrospective cohort study included all patients who underwent a redo cardiac surgical procedure in which the initial and subsequent procedures were performed through a median sternotomy at the Queen Elizabeth II Health Sciences Centre in Halifax, Canada from March 1995 to December 2010. Thoracotomy procedures, ventricular assist device implantations, and transplantations were excluded from the study population. Indications for redo procedures were based on a weekly peer
Patient Population
Between March 1995 and December 2010, 17,645 patients underwent cardiac procedures at the Queen Elizabeth II Health Sciences Centre. Of these patients, 1,521 (8.6%) underwent a redo cardiac surgical procedure in which the first and subsequent procedures were performed through a median sternotomy; these patients were included in the analysis. The majority of the patients were men (69.5%) and the average age was 63.3 years ± 14.3 years; 17.7% of patients who underwent redo procedures had an EF
Comment
We identified a large group of patients undergoing redo cardiac procedures (n = 1521) and reported an unadjusted in-hospital mortality rate of 9.7%, significantly higher than the mortality rate of patients undergoing a first-time procedure at the same institution during the study period, which was 3.4%. Several independent predictors of mortality were identified, including the composite urgency variable, older age, number of redo procedures, current procedure type, preoperative renal failure,
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2022, Journal of Thoracic and Cardiovascular SurgeryInstitutional case volume-incorporated mortality risk prediction model for cardiac surgery
2022, Asian Journal of SurgeryCitation Excerpt :In addition to incorporating institutional case volume, our models offer risk prediction for patients undergoing reoperation and thoracic aorta surgery. Reoperation is considered an important predictive factor for mortality for cardiac surgery patients and had been incorporated in a mortality prediction models.22 Without separate consideration for reoperation, the risk for these patients may be underestimated as reoperations would be considered equal to operations that did not require reoperation.
Reoperative Cardiac Surgery Is a Risk Factor for Long-Term Mortality
2020, Annals of Thoracic SurgeryCitation Excerpt :Adverse events during reoperative cardiac surgery are related to the complexity of the procedure and have been associated with a lack of preventative strategies for sternal reentry.39 Protocol-driven approaches (eg, routine femoral cannulation access and preoperative computed tomography angiography) have shown some promise in reducing associated mortality from sternal reentry,40 and standardized preoperative risk assessment can aid in operative planning.14 Beyond efforts to minimize perioperative morbidity and mortality, it is important to consider the long-term impact of multiple cardiac reoperations on the patient and the hospital system.