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Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends,
Rajendra H Mehta1, Shubin Sheng, Sean M O'Brien
1Duke Clinical Research Institute, Durham, NC 27715, USA. mehta007@dcri.duke.edu
Insights
Reoperation for bleeding after coronary artery bypass surgery (CABG) affects 2.4% of patients. While mortality risk has decreased over time, a new risk score can help identify high-risk individuals for preventive measures.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Patient Safety
Background:
- Reoperation for bleeding is a significant complication following coronary artery bypass surgery (CABG).
- Limited data exists on risk factors and outcomes for this specific complication.
Purpose of the Study:
- To identify risk factors for reoperation due to bleeding after CABG.
- To develop and validate a risk score for predicting reoperation for bleeding.
- To analyze trends in patient outcomes for this complication over time.
Main Methods:
- Analysis of a large cohort of 528,686 CABG patients from the Society of Thoracic Surgeons National Cardiac Database (2004-2007).
- Logistic regression modeling to identify predictors of reoperation for bleeding.
- Development and validation of an additive risk score for bedside use.
Main Results:
- A total of 12,652 CABG patients (2.4%) required reoperation for bleeding, with stable rates from 2004-2007.
- Operative mortality was significantly higher in patients requiring reoperation (9.1% vs 2.0%).
- Mortality risk for reoperated patients decreased significantly over the study period.
Conclusions:
- Reoperation for bleeding remains a critical adverse event post-CABG.
- Despite its morbidity, the mortality associated with this complication has declined.
- A validated risk score can aid in identifying at-risk patients for targeted preventive strategies.
Background:
Reoperation for bleeding represents an important complication in patients undergoing coronary artery bypass surgery (CABG). Yet, few studies have characterized risk factors and patient outcomes of this event.
Methods And Results:
We evaluated 528 686 CABG patients at >800 hospitals in the Society of Thoracic Surgeons National Cardiac Database (2004 to 2007). Clinical features and in-hospital outcomes were evaluated in patients with and without reoperation for bleeding after CABG. Logistic regression was used to identify predictors of risk of this event and to estimate weights for an additive risk score. A total of 12 652 CABG patients (2.4%) required reoperation for bleeding. These rates remained fairly stable over time (2.2%, 2.3%, 2.5%, and 2.4% from 2004 to 2007, respectively). Although overall operative mortality was 4.5-fold higher in patients requiring reoperation for bleeding versus those who did not (2.0% versus 9.1%), this mortality risk declined significantly over time (11.3%, 9.5%, 8.8%, and 8.2% from 2004 to 2007, respectively, P for trend=0.0006). Factors associated with higher risk for reoperation were identified by multivariable analysis (c statistic=0.60) and summarized into a simple bedside risk score. The risk-score performed well when tested in the validation set (Hosmer-Lemeshow P=0.16).
Conclusions:
Reoperation for bleeding remains an important morbid event after CABG. Nonetheless, death in patients with this complication has decreased over time. Our risk tool should allow estimation of patients risk for reoperation for bleeding and promote preventive measures when feasible in this at-risk group.
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