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Hemorrhage After Coronary Artery Bypass Graft Procedures

Published online by Cambridge University Press:  02 January 2015

Loreen A Herwaldt ,
Sheri K. Swartzendruber ,
M. Bridget Zimmerman ,
David A. Scholz ,
Jo Ann Franklin  and
Christopher A. Caldarone
Loreen A Herwaldt*
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa University of Iowa Health Care, Iowa City, Iowa University of Iowa College of Public Health, Iowa City, Iowa
Sheri K. Swartzendruber
Affiliation:
University of Iowa Health Care, Iowa City, Iowa
M. Bridget Zimmerman
Affiliation:
University of Iowa College of Public Health, Iowa City, Iowa
David A. Scholz
Affiliation:
University of Iowa College of Public Health, Iowa City, Iowa
Jo Ann Franklin
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
Christopher A. Caldarone
Affiliation:
Department of Surgery, University of Iowa College of Medicine, Iowa City, Iowa
*
Clinical Outcomes and Resource Management, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242-1081
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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 [CI95], 0.21 to 0.91); age older than 65 years (OR = 1.94; CI95, 0.96 to 3.93); bypass time of 150 minutes or more (OR = 2.91; CI95, 1.09 to 7.81); and postoperative platelet count of 160,000/mm3 or less (OR = 2.36; CI95, 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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 44 - 50
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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