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Published on: September 15, 2023
Outcome after procedures for retained blood syndrome in coronary surgery
Tuomas Tauriainen1, Eeva-Maija Kinnunen1, Joni Koski-Vähälä1
1Department of Surgery, Oulu University Hospital, Oulu, Finland.
Insights
Retained blood syndrome (RBS) procedures after coronary artery bypass grafting (CABG) increase mortality and complications. Early intervention for RBS is crucial for improving patient outcomes following cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Incomplete blood drainage post-cardiac surgery can cause retained blood syndrome (RBS).
- RBS management and outcomes after isolated coronary artery bypass grafting (CABG) require further investigation.
Purpose of the Study:
- To determine the incidence of RBS procedures in isolated CABG patients.
- To evaluate the impact of RBS procedures on early patient outcomes.
Main Methods:
- Retrospective analysis of 2764 patients undergoing isolated CABG (2006-2013).
- Comparison between patients requiring RBS procedures and those who did not.
- Multivariate analyses to assess the effect of RBS procedures on early outcomes.
Main Results:
- 9.2% of patients required RBS procedures.
- RBS procedures were linked to higher 30-day mortality (OR 2.11).
- Increased risks observed for postoperative antibiotics, deep sternal wound infection, acute kidney injury, longer ICU stay, and major adverse events.
Conclusions:
- RBS requiring intervention is associated with significantly increased risks.
- These risks include higher mortality and severe complications after isolated CABG.
- Findings were consistent even in patients without hemodynamic instability.
Objectives:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac surgery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG).
Methods:
A total of 2764 consecutive patients who underwent isolated CABG from 2006 to 2013 were investigated retrospectively. Patients undergoing any procedure for RBS were compared with patients who did not undergo any procedure for RBS. Multivariate analyses were performed to assess the impact of procedures for RBS on the early outcome.
Results:
A total of 254 patients (9.2%) required at least one procedure for RBS. Multivariate analysis showed that RBS requiring a procedure for blood removal was associated with significantly increased 30-day mortality [8.3% vs 2.7%, odds ratio (OR) 2.11, 95% confidence interval (95% CI) 1.15-3.86] rates. Procedures for RBS were independent predictors of the need for postoperative antibiotics (51.6% vs 32.1%, OR 2.08, 95% CI 1.58-2.74), deep sternal wound infection/mediastinitis (6.7% vs 2.2%, OR 3.12, 95% CI 1.72-5.66), Kidney Disease: Improving Global Outcomes acute kidney injury (32.7% vs 15.3%, OR 2.50, 95% CI 1.81-3.46), length of stay in the intensive care unit (mean 8.3 vs 2.0 days, beta 1.74, 95% CI 1.45-2.04) and composite major adverse events (21.3% vs 6.9%, OR 3.24, 95% CI 2.24-4.64). These findings were also confirmed in a subgroup of patients with no pre- or postoperative unstable haemodynamic conditions.
Conclusion:
RBS requiring any procedure for blood removal from pericardial and pleural spaces is associated with an increased risk of severe complications after isolated CABG.
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