Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England

Abstract

Background Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals. Methods Retrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics. Results The study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001). Conclusions Among English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery. Electronic supplementary material The online version of this article (10.1186/s13019-019-0881-3) contains supplementary material, which is available to authorized users.

The incidence and effect of resternotomy following cardiac surgery on morbidity and mortality: a 1‐year national audit on behalf of the Association of Cardiothoracic Anaesthesia and Critical Care

“…The resternotomy rate was 3.6%, but with wide variation between centres ranging from 0.69% to 7.6%. This compares with a resternotomy rate between 0.5% and 6% reported in the literature 5,9. The difference between the centres cannot be explained by the limited data that we collected, but clearly will need further investigation in the future.…”

“…reported in the literature [5,9]. The difference between the centres cannot be explained by the limited data that we A delay in returning to the operating theatre is certainly considered to worsen the outcome for the patient.…”

ABO blood group is related to bleeding in cardiac surgery

“…For example, a multivariate analysis revealed that bleeding and transfusion of red blood cells were associated with an approximately 3‐fold increased risk of operative mortality 3 . Furthermore, bleeding complications are associated with longer stays in the intensive care unit (ICU) and hospital 4 …”

<p>Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model</p>

“…1,2 Major bleeding occurs in up to 10% of adult patients and is a common, clinically important complication increasing re-exploration surgery, length of stay, resources, cost and allogeneic blood transfusion (ABT). [3][4][5] In Australia, cardiothoracic surgery stands as the largest surgical indication of fresh frozen plasma (FFP) and platelet use; and the second most common surgical indication for red blood cells (RBC). 6,7 Major bleeding, blood transfusion, and/or re-exploration surgery have an additive effect of poorer clinical outcomes, including infection, and both early and late mortality.…”