• Michael J Wolf, Kevin O Maher, Kirk R Kanter, Brian E Kogon, Nina A Guzzetta, and William T Mahle.
• Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga. Electronic address: wolfm@kidsheart.com.
• J. Thorac. Cardiovasc. Surg.. 2014 Aug 1;148(2):631-6.e1.

ObjectiveInfants undergoing cardiac surgery often have postoperative bleeding contributing to the occurrence of adverse events. A quantitative evaluation of postoperative bleeding has not been well described.MethodsWe identified 1071 infants who had undergone cardiopulmonary bypass from August 1, 2008 to December 31, 2011. The volume of postoperative bleeding and its effect on mortality were reviewed.ResultsPostoperative bleeding during the first 12 hours postoperatively was stratified by quartiles. Bleeding was significantly associated with increased mortality (odds ratio [OR], 1.15; 95% confidence interval [CI] 1.10-1.21; P < .001). Other risk factors significantly associated with mortality included greater Risk Adjustment for Congenital Heart Surgery score (OR, 1.5; 95% CI, 1.22-1.85; P < .001), single ventricle anatomy (OR, 3.09; 95% CI, 1.68-5.67; P < .001), younger age (OR, 0.99; 95% CI, 0.98-0.99; P < .001), and longer perfusion time (OR, 1.01; 95% CI, 1.01-1.02; P < .001). Subjects with greater bleeding volumes experienced a longer postoperative mechanical ventilation and intensive care unit stay. The overall hospital mortality was 4.1%. On multivariate analysis, adjusting for age, single ventricle anatomy, Risk Adjustment for Congenital Heart Surgery score, and perfusion time, an increasing bleeding volume was independently associated with increased mortality. Packed red blood cell transfusion was independently associated with an increased duration of mechanical ventilation (P = .01) and intensive care unit length of stay (P = .003).ConclusionsEarly postoperative hemorrhage was independently associated with an increased mortality in infants after cardiac surgery. The longer interval from surgery to death suggests that other factors, aside from the bleeding itself, including the transfusion volume, might contribute to mortality. Initiatives to limit postoperative bleeding and to critically appraise packed red blood cell transfusion practices are warranted.Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

37 keywords...

hide…