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Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study.

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Active bleeding after cardiac surgery (AB) affects 2.6% of patients. A new definition based on chest tube blood loss and reoperation helps assess early bleeding, guiding management and identifying complication risks.

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Area of Science:

  • Cardiovascular Surgery
  • Critical Care Medicine
  • Hematology

Background:

  • Postoperative bleeding is a significant concern following cardiac surgery.
  • Standardized definitions for active bleeding (AB) are lacking, complicating accurate incidence estimation and management.
  • Chest drainage monitoring is crucial for assessing intraoperative and postoperative blood loss.

Purpose of the Study:

  • To establish a precise definition for active bleeding (AB) post-cardiac surgery based on chest tube output.
  • To determine the incidence, characteristics, and management strategies for AB.
  • To identify risk factors associated with postoperative complications in cardiac surgery patients.

Main Methods:

  • A prospective, longitudinal observational study was conducted across 29 French centers.
  • Active bleeding (AB) was defined as blood loss > 1.5 ml/kg/h for 6 consecutive hours within 24 hours or reoperation for hemostasis within 12 hours.
  • Logistic regression analysis identified risk factors for postoperative complications.

Main Results:

  • The incidence of active bleeding (AB) was 2.6% (129/4,904 patients), with 52 requiring reoperation.
  • AB incidence varied significantly between centers (0-16%) but was not linked to surgical experience.
  • Risk factors for postoperative complications included body surface area, preoperative creatinine, emergency surgery, acidosis, and red blood cell transfusion.

Conclusions:

  • The proposed definition of active bleeding (AB) (> 1.5 ml/kg/h for 6 hours or early reoperation) is a relevant and objective measure.
  • This definition, independent of transfusion and adjusted for body weight, allows for real-time assessment of early postoperative bleeding.
  • Accurate AB assessment can improve clinical practice and patient outcomes.