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George C. Kaiser
Keith S. Naunheim
Andrew C. Fiore
Howard H. Harris
Lawrence R. McBride
Hendrick B. Barner
Vallee L. Willman
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Ann Thorac Surg 1990;49:903-908
© 1990 The Society of Thoracic Surgeons

Articles

Reoperation in the intensive care unit

George C. Kaiser, MD*, Keith S. Naunheim, MD, Andrew C. Fiore, MD, Howard H. Harris, MD, Lawrence R. McBride, MD, D.Glenn Pennington, MD, Hendrick B. Barner, MD, Vallee L. Willman, MD

Departments of Surgery, St. Louis University School of Medicine and St. Mary's Health Center, St. Louis, Missouri USA

* Address reprint requests to Dr Kaiser, Department of Surgery, 3635 Vista Ave, PO Box 15230, St. Louis, MO 63110-0250.

From July 1, 1984, through June 30, 1989, after 1,239 open heart operations, 110 patients (8.7%) underwent 162 early reoperations either in the intensive care unit (144 procedures) or in the operating room (26 procedures). Reexploration for bleeding (49 procedures) (3.9%) and intraaortic balloon removal (50 procedures) (4.0%) were the two most common procedures. Ninety percent and 96% of these procedures, respectively, were performed in the intensive care unit. Mediastinal infections occurred in 4 (6.1%) of 66 patients undergoing repeat mediastinal operations for all indications. No infection occurred after reexploration for bleeding nor did mediastinal infection occur after reoperation in the intensive care unit. Post-operative death in these 110 patients was not related to reoperation except possibly in the case of 1 patient (0.9%). Average transit time to and from the operating room for patients returned there for reoperation was 89.7 minutes. Charges for procedures performed in the operating room were at least twice as great as for those performed in the intensive care unit. This experience supports expanded use of reoperation in the intensive care unit, as it is safe, effective, economical, and convenient.




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