Faculty Collaboration Database

Mitigating the Risk: Transfusion or Reoperation for Bleeding After Cardiac Surgery. Ann Thorac Surg 2020 Aug;110(2):457-463

Date

12/24/2019

Pubmed ID

31866482

DOI

10.1016/j.athoracsur.2019.10.076

Scopus ID

2-s2.0-85083744210 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Several studies have established morbidity associated with bleeding after cardiac surgery. Although reoperation has been implicated as the marker for this morbidity, there remains limited understanding regarding relative morbidities of reoperation and substantial transfusion.

METHODS: The Society of Thoracic Surgeons (STS) Maryland Adult Cardiac Surgery Database (July 2011-September 2018) was reviewed (N = 23,240). Substantial transfusion was defined as requiring greater than the reoperation group median red blood cells (5 units) and non-red blood cells (4 units). Patients were stratified into 4 subgroups: group 1, no reoperation without substantial transfusion (n = 22,365); group 2, reoperation without substantial transfusion (n = 351); group 3, no reoperation with substantial transfusion (n = 350); and group 4, reoperation with substantial transfusion (n = 167). Operative morbidity and mortality were compared.

RESULTS: Reoperation patients were older with a higher STS predicted risk of mortality (1.8% vs 1.2%, P < .001). Multivariable analysis demonstrated that group 4 increased the odds of renal failure (odds ratio [OR] 7.36, P < .001), stroke (OR 3.24, P = .002), and operative mortality (OR 8.68, P < .001) compared with group 1. Both group 2 and group 3 increased the odds of mortality and renal failure compared with group 1. However, group 3 had greater risk for renal failure (OR 3.48, P < .001) and mortality (OR 2.91, P < .001) than group 2.

CONCLUSIONS: Although reoperation for bleeding is associated with morbidity after cardiac surgery, substantial transfusion without reoperation appears to increase morbidity compared with a limited-transfusion reoperative approach. Better timing for reoperation and guided transfusion approaches may mitigate morbidity compared with substantial transfusion alone.

Author List

Pasrija C, Ghoreishi M, Whitman G, Ad N, Alejo DE, Holmes SD, Schena S, Salenger R, Mazzeffi MA, Fonner CE, Taylor B, Investigators for the Maryland Cardiac Surgery Quality Initiative

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Blood Transfusion
Cardiac Surgical Procedures
Cohort Studies
Female
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Risk Assessment