Risk Factors And Prognosis For Excessive Bleeding In Patients Undergoing Open Heart Surgery With Cardiopulmonary Bypass

Objective:To evaluate the pre-and intraoperative risk factors associated with excessive bleeding during the perioperative period and prognosis in adult patients undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods:1079consecutive patients receiving open heart surgery with CPB from January2001to May2010were included in this study(except emergency operation). The possible risk factors associated with excessive bleeding were retrospectively analyzed. Patients who received>7units of RBC or had a re-operation during which no active bleeding point was found within one day of surgery were classified as excessive bleeding.The patients were divided into2groups according to the occurrence of excessive bleeding:excessive bleeding group and non-excessive bleeding group. The possible risk factors and prognosis associated with excessive bleeding were retrospectively analyzed. The relationship between excessive bleeding and prognosis was also analyzed. Univariate analysis and multivariate logistic regression anaylsis were used to examine the relationship between these factors and excessive bleeding.Results:Of the1079patients included,120(11.1%) developed excessive bleeding. According to univariate analysis, the factors associate with the development of excessive bleeding were age, preoperative hematocrit concentration, preoperative cardiac function, previous sternotomy, hypertension, preoperative coagulation, CPB duration, hemostatic drug, type of procedure and the surgeon. Multivariate logistic analysis indicated that the risk factors for excessive bleeding were age (OR=4.533,95%CI2.624-7.831), previous sternotomy (OR=2.781,95%CI1.410-5.486), preoperative hematocrit concentration (OR=0.896,95%CI0.861-0.932), CPB duration (OR=2.782,95%CI1.791-4.322) and type of procedure (OR=2.292,95%CI1.376-3.817). The patients with excessive bleeding had a bad prognosis with longer ventilation time, ICU stay, hospital stay and a higher morbidity and mortality.Conclusion:Age≥65years, previous sternotomy, preoperative low hematocrit concentration, CPB duration≥120min and Complex surgery were significant predictors for excessive bleeding in patient undergoing open heart surgery with CPB. The patients with excessive bleeding had a bad prognosis.