Objectives: We studied the incidence and risk factors of reoperation for bleeding following CABG in a nationwide cohort with focus on long-term complications and survival. Design: A retrospective study on 2060 consecutive, isolated CABG patients operated 2001–2016. Outcome of reoperated patients (n = 130) were compared to non-reoperated ones (n = 1930), including major adverse cardiac and cerebrovascular events (MACCE) and overall survival. Risk factors for reoperation were determined using multivariate logistic regression and a Cox proportional hazards model to assess prognostic factors of long-term survival. Median follow-up was 7.6 years. Results: One hundred thirty patients (6.3%) were reoperated with an annual decrease of 4.1% per year over the study period (p=.04). Major complications (18.5 vs. 9.6%) and 30-day mortality (8.5 vs. 1.9%,) were higher in the reoperation group (p<.001). The use of clopidogrel preoperatively (OR 3.62, 95% CI: 1.90–6.57) and reduced left ventricular ejection fraction (OR 2.23, 95% CI: 1.25–3.77) were the strongest predictors of reoperation, whereas off-pump surgery was associated with a lower reoperation risk (OR 0.44, 95% CI: 0.22–0.85). After exluding patients that died within 30 days postoperatively, no difference in long-term survival or freedom from MACCE was found between groups, and reoperation was not an independent risk factor for long-term mortality in multivariate analysis. Conclusions: The reoperation rate in this study was relatively high but decreased significantly over time. Reoperation was associated with twofold increased risk for major complications and fourfold 30-day mortality, but comparable long-term MACCE and survival rates. This implies that if patients survive the first 30 days following reoperation, their long-term outcome is comparable to non-reoperated patients.

目的：我们研究了全国队列中CABG术后再次手术出血的发生率和危险因素，重点是长期并发症和生存率。设计：一项回顾性研究，研究对象为2001年至2016年间连续进行的2060例孤立的CABG患者。再次手术的患者（的结果ñ  = 130）进行了比较，非再次手术者（ñ  = 1930），包括主要不良心脏和脑血管事件（MACCE）和总生存期。使用多元逻辑回归和Cox比例风险模型确定再次手术的危险因素，以评估长期生存的预后因素。中位随访时间为7.6年。结果：130名患者（6.3％）再次手术，在研究期内每年下降4.1％（p = .04）。再次手术组的主要并发症（18.5比9.6％）和30天死亡率（8.5比1.9％）更高（p <.001）。术前使用氯吡格雷（OR 3.62，95％CI：1.90–6.57）和降低左心室射血分数（OR 2.23，95％CI：1.25–3.77）是再次手术的最强预测指标，而非体外循环手术与再次手术相关再手术风险较低（OR 0.44，95％CI：0.22-0.85）。排除术后30天内死亡的患者后，各组之间的长期生存或无MACCE差异无统计学意义，并且在多因素分析中，再次手术并不是长期死亡的独立危险因素。结论：本研究的再手术率较高，但随着时间的推移明显降低。再次手术与发生重大并发症的风险增加两倍，30天死亡率增加四倍有关，但长期MACCE和生存率相当。这意味着，如果患者在再次手术后的前30天存活，则其长期结局可与未再次手术的患者相提并论。