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- W4387633383 abstract "Risk factors for severe post-operative bleeding after cardiac surgery remain multiple and incompletely elucidated. We evaluated the impact of intraoperative blood product transfusions, IV fluid administration, and persistently low core body temperature (CBT) at ICU arrival on risk of perioperative bleeding leading to reexploration.We retrospectively queried our tertiary care center's Society of Thoracic Surgeons Institutional Database for all index, on-pump, adult cardiac surgery patients between July 2016 and September 2022. Intraoperative fluid (crystalloid and colloid) and blood product administrations, as well as perioperative CBT data, were harvested from electronic medical records. Linear and non-linear mixed models, treating surgeon as a random effect to account for inter-surgeon practice differences, were used to assess the association between above factors and reexploration for bleeding.Out of 4,037 patients, 151 (3.7%) underwent reexploration for bleeding. Reexplored patients experienced remarkably higher post-operative morbidity (23% vs. 6%, p<0.001) and 30-day mortality (14% vs. 2%, p<0.001). In linear models, progressively increasing IV crystalloid administration (adjusted odds ratio/aOR=1.11, 95%CI: 1.03-1.19) and decreasing CBT on ICU arrival (aOR=1.20, 95%CI: 1.05-1.37) were associated with higher risk of bleeding leading to reexploration. Non-linear analysis revealed increasing risk after ∼6L of crystalloid administration and a U-shaped relationship between CBT and reexploration risk. Intraoperative blood product transfusion of any kind was not associated with reexploration.We found evidence of both dilution- and hypothermia-related effects associated with perioperative bleeding leading to reexploration in cardiac surgery. Interventions targeting modification of such risk factors may decrease the rate this complication." @default.
- W4387633383 created "2023-10-14" @default.
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- W4387633383 date "2023-10-01" @default.
- W4387633383 modified "2023-10-17" @default.
- W4387633383 title "Impact of Intraoperative Blood Products, Fluid Administration, and Persistent Hypothermia on Bleeding Leading to Reexploration After Cardiac Surgery" @default.
- W4387633383 doi "https://doi.org/10.1016/j.jtcvs.2023.10.011" @default.
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- W4387633383 hasPublicationYear "2023" @default.
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