Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England

• Published in: Journal of cardiothoracic surgery Vol. 14; no. 1; pp. 64 - 10
• Main Authors: Al-Attar, Nawwar, Johnston, Stephen, Jamous, Nadine, Mistry, Sameer, Ghosh, Ena, Gangoli, Gaurav, Danker, Walter, Etter, Katherine, Ammann, Eric
• Format: Journal Article
• Language: English
• Published: London BioMed Central 02.04.2019; BioMed Central Ltd; BMC
• Subjects: Aorta; Bleeding; Blood products; Cardiac patients; Cardiac Surgery; Cardiac Surgical procedures; Care and treatment; Clinical medicine; Codes; Complications; Coronary artery; Coronary artery bypass; Coronary vessels; Costs and cost Analysis; Critical care; Data warehouses; Evidence-based medicine; Haemorrhage; Heart; Heart surgery; Hospital patients; Hospitals; Independent variables; Length of stay; Medical research; Medicine; Medicine & Public Health; Morbidity; Mortality; Patients; Repair; Research Article; Sensitivity analysis; Statistical models; Surgery; Thoracic Surgery; Utilization; Veins & arteries; United Kingdom > UK; England; Cardiac Surgical procedures; Haemorrhage; Costs and cost Analysis; Complications; Length of stay
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-019-0881-3

Background 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. Methods Retrospective, 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. Results The 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). Conclusions Among 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.