Email this article The predictive impact of perioperative hypofibrinogenemia on re-exploration in cardiac surgery: Insights from a single-center analysis
DOI: https://doi.org/10.20528/cjpm.2026.01.001
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Background: Postoperative bleeding in cardiac surgery is a serious complication associated with increased morbidity, mortality, and healthcare costs. The objective of this study was to identify independent risk factors for re-exploration due to bleeding in patients undergoing cardiac surgery, with a particular emphasis on the predictive role of perioperative hypofibrinogenemia.
Methods: In this single-center retrospective observational cohort study, a total of 593 consecutive adult patients who underwent cardiac surgery between January 1, 2025, and June 30, 2025, were retrospectively reviewed. The primary endpoint was surgical re-exploration for bleeding within 48 hours postoperatively. Demographic characteristics, comorbidities, laboratory parameters, surgical variables, and postoperative complications were recorded. Variables found to be significant in univariate analysis were further analyzed using multivariate logistic regression. The threshold value of postoperative fibrinogen for predicting re-exploration risk was calculated.
Results: The overall re-exploration rate was 15.6%. Approximately 10% of cases were urgent surgeries. Independent risk factors identified in multivariate analysis were female sex (OR=2.7; p=0.001), age ≥65 years (OR=2.0; p=0.011), body mass index (BMI) outside the normal range (OR=2.7; p=0.002), preoperative fibrinogen <1.5 g/L (OR=3.7; p=0.007), and postoperative fibrinogen <1.5 g/L (OR=2.7; p=0.012). The ROC analysis for postoperative fibrinogen was statistically significant (AUC=0.691; 95% CI 0.629–0.752; p<0.001). The optimal cut-off was 2.06 g/L (Youden index=0.346), with 79.8% sensitivity and 54.8% specificity. Patients undergoing re-exploration had significantly longer ICU stays (p<0.001) and higher mortality rates (p<0.001).
Conclusions: The risk of re-exploration in cardiac surgery is increased in association with female sex, advanced age, abnormal BMI, and particularly perioperative hypofibrinogenemia. A preoperative fibrinogen level <1.5 g/L emerged as the strongest predictor. These findings suggest that close monitoring of fibrinogen and early replacement strategies may play a critical role in reducing re-exploration rates.
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