Faculty Collaboration Database

Validation of a definition of excessive postoperative bleeding in infants undergoing cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg 2018 May;155(5):2112-2124.e2

Date

01/18/2018

Pubmed ID

29338867

DOI

10.1016/j.jtcvs.2017.12.038

Scopus ID

2-s2.0-85040453070 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

OBJECTIVE: To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass.

METHODS: Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates.

RESULTS: Excessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period.

CONCLUSIONS: The proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives.

Author List

Bercovitz RS, Shewmake AC, Newman DK, Niebler RA, Scott JP, Stuth E, Simpson PM, Yan K, Woods RK

Authors

Debra K. Newman PhD Investigator in the Blood Research Institute department at BloodCenter of Wisconsin
Debra K. Newman PhD Professor in the Pharmacology and Toxicology department at Medical College of Wisconsin
Robert Niebler MD Professor in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD Professor in the Anesthesiology department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin

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

Age Factors
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Chest Tubes
Drainage
Erythrocyte Transfusion
Female
Hospital Mortality
Humans
Infant
Infant, Newborn
Length of Stay
Male
Patient Readmission
Postoperative Hemorrhage
Prospective Studies
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Terminology as Topic
Time Factors
Treatment Outcome