POST-OPERATIVE COMPLICATIONS IN CARDIAC SURGERY PATIENTS

Abstract

TOPIC: Cardiothoracic Surgery TYPE: Original Investigations PURPOSE: Perioperative coagulopathy and postoperative bleeding are the most common complications in patients undergoing cardiac surgery, especially when the cardiovascular surgery is associated with cardiopulmonary bypass (CPB). In this context, some studies suggest that implementation of viscoelastic point-of-care tests (POCT), such as rotational thrombo-elastometry, in conjunction with a specific algorithm for coagulation management in cardiac surgery, allow for better control of hemostatic pathology. METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. This first group (N=336) is characterized by having received perioperative transfusion therapy based on conventional laboratory coagulation tests and clinical judgment. This second group (n=339) is characterized by having received perioperative transfusion therapy based on the results of the ROTEM® viscoelastic point-of-care test system and a specific coagulation management algorithm. RESULTS: Following viscoelastic testing and the implementation, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p=0.026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p=0.002) and fresh frozen plasma (9.8% vs 3.8%, p=0.008). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p=0,530) and fibrinogen concentrate (0.9% vs 3.5%, p=0.066). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p=0.813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p=0.037) and surgical reexploration (6.0% vs 2.9%, p=0.035).Thus, the incidence of cardiac surgery complications in ICU decreased (55.8% vs 57.7%, p=0.275), especially acute postoperative pericarditis (3.6% vs 1.2%, p=0.043).Finally, we observed a lower rate of ICU readmissions for viscoelastic testing patients (4.6% VS 2.7%, p=0.201); and statistically significant reductions were detected in length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p=0.026).In addition, we observed a decreased in total hospital stay (16.7 ±10.0 days vs 18.3±13.5 days, p=0.076), and in hospital mortality associated with cardiac surgery (4.5% vs 2.4%, p=0.132). CONCLUSIONS: The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic and cardiac postoperative complications and lengths of ICU stay. CLINICAL IMPLICATIONS: Finally, we have achieved great results, including decreased incidence of blood transfusion, decreased complications, lower lengths of stay in the ICU and a reduction cardiac surgery hospital cost (622,008 euros vs 312,750 euros). after ROTEM implementation. DISCLOSURES: No relevant relationships by Isabel Rodríguez Martín, source=Web Response