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Early postoperative bleeding is independently associated with increased surgical mortality in infants after
Michael J Wolf1, Kevin O Maher1, Kirk R Kanter2
1Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.
Insights
Postoperative bleeding in infants after cardiac surgery significantly increases mortality risk. Limiting bleeding and critically evaluating blood transfusions are crucial for improving outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Hematology
Background:
- Infants undergoing cardiac surgery are at high risk for postoperative bleeding, a known contributor to adverse events.
- Quantitative assessment of postoperative bleeding in this population remains inadequately described.
Purpose of the Study:
- To quantitatively evaluate the volume of postoperative bleeding in infants following cardiac surgery.
- To determine the association between postoperative bleeding and mortality in this cohort.
Main Methods:
- A retrospective review of 1071 infants who underwent cardiopulmonary bypass between August 1, 2008, and December 31, 2011.
- Stratification of postoperative bleeding volumes into quartiles and analysis of their correlation with mortality and other clinical outcomes.
Main Results:
- Postoperative bleeding within the first 12 hours was significantly associated with increased mortality (OR, 1.15; 95% CI, 1.10-1.21).
- Higher bleeding volumes correlated with longer mechanical ventilation and intensive care unit (ICU) stays.
- Multivariate analysis confirmed that increased bleeding volume was an independent predictor of mortality, even after adjusting for factors like age, single ventricle anatomy, and perfusion time.
Conclusions:
- Early postoperative hemorrhage is an independent risk factor for mortality in infants after cardiac surgery.
- The findings suggest that factors beyond immediate bleeding, such as transfusion volume, may influence mortality.
- Strategies to minimize postoperative bleeding and optimize packed red blood cell transfusion practices are recommended.
Objective:
Infants 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.
Methods:
We 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.
Results:
Postoperative 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).
Conclusions:
Early 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.
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