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Validation of the E-CABG Bleeding Severity Classification in Open Peripheral Arterial Surgery

T A H Steunenberg1, J P Hakbijl2, L C Roosendaal3

  • 1Department of Vascular Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Vascular Surgery, Dijklander Hospital, Hoorn, The Netherlands; Amsterdam Cardiovascular Sciences, Atherosclerosis & Aortic Disease, Amsterdam, The Netherlands.

Annals of Vascular Surgery
|August 15, 2025
PubMed

Insights

The European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding classification effectively assesses perioperative bleeding severity in open peripheral arterial surgery (OPAS). This classification predicts adverse outcomes, aiding research and patient safety.

Area of Science:

  • Vascular Surgery
  • Surgical Outcomes Research
  • Patient Safety

Background:

  • Accurate documentation of perioperative bleeding is vital for vascular procedures.
  • The European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding classification requires validation for open peripheral arterial surgery (OPAS).

Purpose of the Study:

  • To validate the E-CABG bleeding classification system in patients undergoing OPAS.
  • To assess the predictive capability of the E-CABG classification for adverse patient outcomes.

Main Methods:

  • Prospective, multicenter cohort study of adult patients undergoing elective OPAS (excluding abdominal aortic surgery).
  • Complications were categorized using the E-CABG grading system.
  • Logistic regression analysis evaluated the prediction of Grade I or higher bleeding for patient outcomes, adjusted for OPAS type.

Main Results:

  • 12% of 778 patients experienced bleeding complications (Grade I or II).
  • Patients with Grade ≥ I bleeding had significantly higher rates of thrombo-embolic complications, myocardial infarction, graft thrombosis, wound infection, pneumonia, reoperation, and mortality.
  • The E-CABG Grade ≥ I classification predicted 30-day mortality (AUC 0.81), reoperation (AUC 0.75), wound infection (AUC 0.76), and thrombo-embolic complications (AUC 0.67).

Conclusions:

  • The E-CABG bleeding classification is applicable for stratifying bleeding severity in OPAS.
  • The classification effectively predicts adverse short-term postoperative outcomes, supporting its use in research and registries.
Abstract

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