Evaluation of Factors Affecting Bleeding in Coronary Artery Bypass Surgery

Öz

Aim: Postoperative bleeding is one of the most frequently encountered complications following coronary artery bypass grafting (CABG). This study aims to investigate preoperative and intraoperative risk factors affecting postoperative bleeding in CABG surgery. Methods: A total of 242 patients who underwent CABG between March 2019 and January 2023 were retrospectively analyzed. Based on postoperative bleeding volume, patients were classified into two groups: normal bleeding (Group N) and excessive bleeding (Group B). The groups were compared in terms of demographic, clinical, and perioperative variables. Results: Patients in Group B demonstrated significantly lower preoperative platelet counts (p=0.005), a lower prevalence of COPD (p=0.01), and longer anesthesia durations (p=0.033). Logistic regression analysis identified the absence of COPD (OR: 0.202; 95% CI: 0.054–0.759) and low platelet levels (OR: 0.995; 95% CI: 0.991–0.999) as independent predictors of excessive bleeding after CABG surgery. Conclusion: The findings indicate that reduced preoperative platelet count and the absence of COPD are significant risk factors for excessive bleeding following CABG. Moreover, these patients exhibited higher rates of postoperative complications and mortality.

Anahtar Kelimeler

• Bleeding
• cardiac surgery
• mortality
• postoperative complications

Koroner Arter Bypass Cerrahisinde Kanamaya Etki Eden Faktörlerin Değerlendirilmesi

Öz

Amaç: Koroner arter bypass greftleme (CABG) cerrahisi sonrasında karşılaşılan en önemli komplikasyonlardan biri postoperatif kanamadır. Bu çalışmanın amacı, CABG cerrahisi geçiren hastalarda postoperatif kanamayı etkileyen preoperatif ve intraoperatif risk faktörlerini araştırmaktır. Yöntem: Bu çalışmada Mart 2019 ile Ocak 2023 tarihleri arasında CABG cerrahisi uygulanan 242 hasta retrospektif olarak değerlendirildi. Postoperatif dönemde kanama miktarına göre hastalar normal kanama (Grup N) ve aşırı kanama olanlar (Grup B) şeklinde iki gruba ayrıldı. Gruplar demografik, klinik ve perioperatif değişkenler açısından karşılaştırıldı. Bulgular: Grup B'deki hastalarda anlamlı bir şekilde daha düşük preoperatif trombosit sayısı (p=0,005), daha düşük KOAH prevalansı (p=0,01) ve daha uzun anestezi süreleri (p=0,033) olduğu saptandı. Lojistik regresyon analizi, KOAH öyküsü olmayışını (OR: 0,202; %95 GA: 0,054–0,759) ve düşük trombosit seviyelerini (OR: 0,995; %95 GA: 0,991–0,999) KABG ameliyatından sonra aşırı kanama için bağımsız risk faktörleri olarak tanımladı. Sonuç: Bu sonuçlar, düşük preoperatif trombosit düzeyi ve KOAH öyküsünün olmamasının, CABG cerrahisi sonrası aşırı kanama için bağımsız risk faktörleri olduğunu ortaya koymuştur. Ayrıca, aşırı kanaması olan hastalarda postoperatif komplikasyonların ve mortalitenin daha sık görüldüğü bulunmuştur.

Anahtar Kelimeler

• Kanama
• kardiyak cerrahi
• mortalite
• postoperatif komplikasyonlar

Kaynakça

1. Alexander JH, Smith PK. Coronary-Artery Bypass Grafting. N Engl J Med. 2016;374(20):1954-1964.
2. Montrief T, Koyfman A, Long B. Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med. 2018;36(12):2289-2297.
3. Raphael J, Mazer CD, Subramani S, Schroder A, Abdalla M, Ferreira R, et al. Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients [published correction appears in J Cardiothorac Vasc Anesth. 2020 Mar;34(3):840-841]. J Cardiothorac Vasc Anesth. 2019;33(11):2887-2899.
4. Bastopcu M, Özhan A, Erdoğan SB, Kehlibar T. Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting. J Card Surg. 2021;36(4):1277-1281.
5. Kinnunen EM, De Feo M, Reichart D, Tauriainen T, Gatti G, Onorati F, et al. Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients. Transfusion. 2017 Jan;57(1):178-186.
6. Gunertem E, Urcun S, Pala AA, Budak AB, Ercisli MA, Gunaydin S. Predictiveness of different preoperative risk assessments for postoperative bleeding after coronary artery bypass grafting surgery. Perfusion. 2021;36(3):277-284.
7. Christensen MC, Krapf S, Kempel A, von Heymann C. Costs of excessive postoperative hemorrhage in cardiac surgery. J Thorac Cardiovasc Surg. 2009;138(3):687-693.
8. Dyke C, Aronson S, Dietrich W, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147(5):1458-1463.e1.

9. Biancari F, Brascia D, Onorati F, et al. Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score. Thrombosis and Haemostasis. 2017 Feb;117(3):445-456.
10. Classes and Stages of Heart Failure | American Heart Association [Internet]. [cited 2024 Jun 10]. Available from: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure
11. EuroScore Website-calculator [Internet]. [cited 2024 Jun 10]. Available from: https://www.euroscore.org/index.php?id=17
12. Özbayrak İ, Amanvermez Şenarslan D, Yıldırım F, Yaldır Kayalı O, Açıkel A, Öztürk T. Causes of excessive bleeding in patients who underwent open-heart surgery during the early postoperative period. GKDA Derg 2024;30(1):1-8
13. Lopes CT, Dos Santos TR, Brunori EH, Moorhead SA, Lopes Jde L, Barros AL. Excessive bleeding predictors after cardiac surgery in adults: integrative review. J Clin Nurs. 2015;24(21-22):3046-3062.
14. Rodrigues ARB, Benevides LMB, Crespo JCL, Santana-Santos E, Püschel VAA, Oliveira LB. Factors associated with reoperation due to bleeding and outcomes after cardiac surgery: a prospective cohort study. Rev da Esc Enferm. 2022;56(SpecialIssue):1–7.
15. Lopes CT, Brunori EF, Cavalcante AM, Moorhead SA, Swanson E, Lopes Jde L, et al. Factors associated with excessive bleeding after cardiac surgery: A prospective cohort study. Heart Lung. 2016;45(1):64-69.e2.
16. Mallah H, Ball S, Sekhon J, Parmar K, Nugent K. Platelets in chronic obstructive pulmonary disease: An update on pathophysiology and implications for antiplatelet therapy. Respir Med. 2020 Sep;171:106098.
17. Reiche S, Mpanya D, Vanderdonck K, Mogaladi S, Motshabi-Chakane P, Tsabedze N. Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa. J Cardiothorac Surg. 2021;16(1):1–8.
18. Björklund E, Enström P, Nielsen SJ, Tygesen H, Martinsson A, Hansson EC, et al. Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting. Heart. 2023;110(8):569–77.