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Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study
Journal article   Peer reviewed

Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study

Camila T Lopes, Evelise H Fadini Reis Brunori, Vinicius Batista Santos, Sue A Moorhead, Juliana de Lima Lopes and Alba L Bottura Leite de Barros
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, Vol.15(3), pp.e70-e77
04/2016
DOI: 10.1177/1474515115583407
PMID: 25888608

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Abstract

Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated. To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding. This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients' charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and specificity. The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%. Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding.
 Reoperation Prospective Studies Postoperative Hemorrhage - surgery Humans Middle Aged Risk Factors Logistic Models Male Cardiac Surgical Procedures - adverse effects Postoperative Hemorrhage - etiology Sensitivity and Specificity Heart Diseases - complications Aged, 80 and over Brazil Adult Female Aged Heart Diseases - surgery Cohort Studies

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