Abstract
BackgroundBleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals.MethodsRetrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics.ResultsThe study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001).ConclusionsAmong English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery.
Highlights
Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality
The Clinical Practice Research Datalink (CPRD) database consists of electronic health record (EHR) data generated as part of standard clinical practice by participating United Kingdom (UK) general practitioners (GPs)
In-hospital mortality Because in-hospital mortality represents a competing risk that may affect the associations between bleeding complications and length of stay (LOS) and critical care utilization, we evaluated the incidence of in-hospital mortality by bleeding status
Summary
Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals. The incidence and clinical burden of bleeding complications in the setting of cardiac surgery have been described in prior studies; [5,6,7, 10] there is limited contemporary data on the impact of bleeding on resource utilization in European countries, for England. Al-Attar et al Journal of Cardiothoracic Surgery (2019) 14:64 in cardiac surgery and their impact on post-procedure length of stay (LOS) and critical care utilization in a nationwide sample of patients treated at English hospitals
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