Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study (original) (raw)
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Factors associated with excessive bleeding after cardiac surgery: A prospective cohort study
Heart & lung : the journal of critical care, 2015
To identify factors associated with excessive bleeding (ExB) after cardiac surgery in adults. Excessive bleeding after cardiac surgery must be anticipated for implementation of timely interventions. A prospective cohort study with 323 adults requiring open-chest cardiac surgery. Potential factors associated with ExB were investigated through univariate analysis and logistic regression. The accuracy of the relationship between the independent variables and the outcome was depicted through the receiver-operating characteristic (ROC) curve. The factors associated with ExB included gender, body mass index (BMI), preoperative platelet count, intraoperative heparin doses and intraoperative platelet transfusion. The ROC curve cut-off points were 26.35 for the BMI; 214,000 for the preoperative platelet count, and 6.25 for intraoperative heparin dose. This model had an accuracy = 77.3%, a sensitivity = 81%, and a specificity = 62%. Male gender, BMI, preoperative platelet count, dose of intra...
Revista da Escola de Enfermagem da USP
Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical ...
Journal of Cardiothoracic Surgery
Background Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. Objective To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. Methods Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. Results Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk fa...
Predictors of post operative bleeding and blood transfusion in cardiac surgery
Ghana Medical Journal, 2010
In spite of the recent advances in heart surgery, patients undergoing cardiac surgery with cardiopulmonary bypass are at risk of developing significant post-operative bleeding and substantial blood requirements. Objective: To evaluate the impact of some perioperative predictors of post-operative bleeding, and blood transfusion after heart surgery and offer suggestions on preventive measures. Design and Methods: A prospective analytical study. The perioperative factors studied were haemoglobin level, international normalised ratio (INR), platelet count, and total bypass time. Eighty-seven consecutive patients who underwent heart surgery in the year 2004 were selected. Each patient had laboratory work up which included full blood count, clotting profile, kidney and liver function tests. The total blood loss within the first twenty-four hours and the total units of blood transfused before the patient was discharged were also recorded. Results: Pre-operative haemoglobin was significant in determining the total units of blood received by a patient. Increasing total bypass time caused a significant increase in the percentage reduction of the pre-operative platelet count (p <0.004). However even though there was an increasing trend of post-operative bleeding with increase in total bypass time, this was not significant from the analysis (p<0.069). The percentage reduction in platelet count and immediate postoperative platelet count were significant predictors of postoperative bleeding (p <0 .009) and (p <0.003) respectively. Conclusion: Pre-operative haemoglobin, percentage reduction in the platelet count after cardiopulmonary bypass and immediate postoperative platelet count are significant predictors of postoperative bleeding and blood requirements.
Risk factors for postoperative bleeding after adult cardiac surgery
Revista Brasileira de …, 2004
Apesar dos grandes avanços alcançados, o sangramento continua sendo uma das principais morbidades em cirurgia cardíaca, particularmente com o advento de procedimentos mais complexos, com períodos prolongados de circulação extracorpórea e intervenções em ...
The Medical journal of Cairo University
Background: In cardiac surgery, excessive blood loss requiring large volume red blood cells (RBCs) is associated with significant morbidity and mortality. There are different variables affecting large volume RBCs transfusion in open heart surgery. The objective of this study is to review transfusion practice in open heart surgery in King Abdul Aziz University Hospital (KAUH) and the risk factors for excessive blood loss and therefore transfusion. Patients and Methods: Data were retrospectively collected on 115 cardiac surgical patients during 2005-2007. The risk factors for large-volume (>4 units) RBCs transfusion were calculated and compared with non or low transfused patients. The risk factors for large volume RBCs transfusion were determined. Results: Large-volume RBCs transfusion >4 units has occurred in 35 (30.4%) patients while 49 (42.6%) were none transfused and 31 (26.95%) received from 1 to 4 units. On analysis of preoperative Hgb of the studied group there was 56 (48.6%) patients were anemic and 59 patients (51.3%) have normal Hgb and there was highly significant difference in the number of PRBCs units transfusion in anemic group on comparison with non anemic group (p<001) and also in patients underwent urgent operation (20 patients, 17.3%) Vs elective surgery (95 patients, 82.6%) (p<0.002), DM patients (19 patients, 16.5%) Vs non diabetic patients (96 patients, 83.4%) (p<0.005). There was positive correlation between number of PRBCs units transfused and increasing age (p=.009) while there was non significant difference in number of PRBCs transfusion in patients with coronary artery bypassing graft (CABG) in comparison with multiple valve replacement (p=0.488) and male patients Vs female (p=0.09). Conclusion: This study confirmed that a high-risk group of patients exists in open heart surgery. Low preoperative hemoglobin, DM, old age and urgent surgical intervention are at higher risk for large-volume blood transfusion while the type of operation or patients sex has non significant risk.
Bleeding After Cardiac Surgery Is Associated With an Increase in the Total Cost of the Hospital Stay
The Annals of Thoracic Surgery, 2020
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Postoperative Bleeding in Cardiac Surgery
Anesthesiology, 2008
Background Plasminogen activator inhibitor 1 (PAI-1) attenuates the conversion of plasminogen to plasmin. Polymorphisms of the PAI-1 gene are associated with varying PAI-1 levels and risk of prothrombotic events in nonsurgical patients. The purpose of this study, a secondary analysis of a clinical trial, was to investigate whether PAI-1 genotype affects the efficacy of tranexamic acid (TA) in reducing postoperative chest tube blood loss of patients undergoing cardiopulmonary bypass. Methods Fifty patients were classified according to PAI-1 genotype (4G/4G, 4G/5G, or 5G/5G). Twenty-four received 2 g TA before and after cardiopulmonary bypass, whereas 26 received placebo. The authors recorded data related to coagulation, fibrinolysis, and bleeding before surgery, at admission to the intensive care unit (0 h), and 4 and 24 h later. Results In patients not receiving TA, those with the 5G/5G genotype had significantly higher chest tube blood loss and transfusion requirements compared wit...