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Hemorrhage After Coronary Artery Bypass Graft Procedures

2003; Cambridge University Press; Volume: 24; Issue: 1 Linguagem: Inglês

10.1086/502114

1559-6834

Loreen A. Herwaldt, Sheri K. Swartzendruber, M. Bridget Zimmerman, David Scholz, Jo Ann Franklin, Christopher A. Caldarone,

Trauma, Hemostasis, Coagulopathy, Resuscitation

Abstract Objectives: To identify risk factors for excessive bleeding after coronary artery bypass graft (CABG) procedures and to quantify the outcomes related to this complication. Design: We conducted a case–control study to identify risk factors for hemorrhage following CABG surgery and a historical cohort study to quantify outcomes of hemorrhage. Setting: The cardiothoracic surgery service of a university hospital. Results: Factors associated with excessive blood loss were recent catheterization (odds ratio [OR] = 0.44; 95% confidence interval [CI 95 ], 0.21 to 0.91); age older than 65 years (OR = 1.94; CI 95 , 0.96 to 3.93); bypass time of 150 minutes or more (OR = 2.91; CI 95 , 1.09 to 7.81); and postoperative platelet count of 160,000/mm3 or less (OR = 2.36; CI 95 , 1.06 to 5.22). The attributable cost of a postoperative hemorrhage was $3,866 ( P = .0002) overall, $9,912 ( P = .0001) for patients who required reoperation, and $3,316 ( P = .03) for those treated medically. The median attributable postoperative length of stay was 1 day longer for cases than for controls ( P = .011). Postoperatively, patients who hemorrhaged received significantly larger volumes of packed red blood cells ( P < .0001), fresh frozen plasma ( P < .0001), platelets ( P < .0001), plasminate ( P = .007), protamine sulfate ( P < .0001), desmopressin acetate ( P < .0001), and epsilon-aminocaproic acid ( P < .0001) than did controls. Conclusions: Age, duration of bypass, and postoperative platelet count were associated with excessive bleeding. Hemorrhage after CABG surgery significantly increased the length of stay and cost of care.