Reoperative Cardiac Surgery Is a Risk Factor for Long-Term Mortality.

Abstract

Reoperative cardiac surgery has been associated with increased morbidity and mortality. Large propensity-matched series comparing all first-time and redo cardiac operations are lacking. The primary objective of the current study was to provide detailed outcomes and risk factors for mortality and readmissions after reoperative cardiac surgery. All patients who underwent cardiac surgery from 2011 to 2017 were included. Propensity matching yielded equitable cohorts. Multivariable Cox regression analysis was performed to identify independent predictors of 30-day, 1-year, and 5-year mortality and readmissions. A total of 14,151 patients underwent cardiac surgery, of which 1700 (12%) had reoperative cardiac surgery. There were significantly (P < .001) more comorbidities in the reoperative cardiac surgery group. Propensity matching yielded 1696 patients in each cohort. After propensity matching, operative mortality (8.37% vs 6.07%; P = .01), blood product transfusion (54.7% vs 46.2%; P < .001), and prolonged ventilator requirements (>24 hours) (20% vs 17%; P = .02) were increased for the reoperative cohort. On multivariable analysis for propensity-matched cohorts, reoperation was an independent predictor of mortality at 30 days (hazard ratio [HR], 1.36; 95% confidence interval [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 = .002). After risk-adjusting for baseline characteristics, the need for reoperation was an independent predictor of both short-term and long-term mortality after reoperative cardiac surgery. These data are relevant when considering alternative therapies such as percutaneous coronary or transcatheter valve interventions.