The Epidemiology of Hemorrhage Related to Cardiothoracic Operations

Loreen A. Herwaldt, Sheri K. Swartzendruber, Michael B. Edmond, Richard P. Embrey, Kim R. Wilkerson, Richard P. Wenzel, Trish M. Perl

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVE: To define the epidemiology, risk factors, and unadjusted cost of hemorrhages related to cardiothoracic operations. STUDY DESIGN: We conducted two case-control studies to evaluate the risk of hemorrhage following cardiothoracic operations. The definition of hemorrhage required one of the following: reoperation for bleeding, postoperative loss of greater than 800 mL of blood over 4 hours, or surgeon-diagnosed excessive intraoperative bleeding. SETTlNG: The cardiothoracic surgery service of a university hospital. RESULTS: Of 511 patients undergoing cardiothoracic operations, 93 (18%) met the definition of hemorrhage. In the first case-control study, 3 (14%) of 21 cases and 0 of 42 controls died (odds ratio [OR], 15.0; 95% confidence interval [CI95], 1.18-191.55). Compared with controls, cases received significantly more packed red blood cells intraoperatively (OR, 1.18/100 mL; CI95, 1.01-1.38), and significantly more platelets (OR, 3.26/100 mL; CI95, 1.47-7.26) and fresh frozen plasma (OR, 1.73/100 mL; CI95, 1.05-.84) in the intensive-care unit. Cases were more likely than controls to receive protamine postoperatively (OR, 3.74; CI95, 1.27-11.02). Previous sternotomy, preoperative aspirin or heparin, and preoperative laboratory values did not predict bleeding. The median unadjusted hospital cost was $3,458 higher for patients who suffered hemorrhage than for controls. To decrease costs, hetastarch (acquisition cost $45/500 mL) was substituted for albumin (acquisition cost $76/100 mL) in the pump priming solution (estimated possible cost savings, $7,000-$53,000/year). Because hemorrhage rates increased subsequently, we conducted a second case-control study that identified patient age (P=.02) and use of greater than 5 mL/kg of hetastarch (OR, 1.82) as risk factors for hemorrhage. The cost of treating hemorrhages exceeded all estimates of possible cost savings ($7,000-$53,000 per year). CONCLUSIONS: Our definition of hemorrhage identified patients who required increased volumes of blood products and who had an increased crude mortality rate and a higher unadjusted cost of hospitalization. Patient age and hetastarch use were risk factors for hemorrhage. Efforts to save money by substituting less expensive products inadvertently may increase costs by increasing the probability of perioperative adverse events.

Original languageEnglish (US)
Pages (from-to)9-16
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume19
Issue number1
DOIs
StatePublished - Jan 1 1998

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Epidemiology
Hemorrhage
Costs and Cost Analysis
Odds Ratio
Hydroxyethyl Starch Derivatives
Case-Control Studies
Cost Savings
Protamines
Sternotomy
Hospital Costs
Blood Volume
Reoperation
Aspirin
Intensive Care Units
Heparin
Albumins
Hospitalization
Blood Platelets
Erythrocytes
Confidence Intervals

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Herwaldt, L. A., Swartzendruber, S. K., Edmond, M. B., Embrey, R. P., Wilkerson, K. R., Wenzel, R. P., & Perl, T. M. (1998). The Epidemiology of Hemorrhage Related to Cardiothoracic Operations. Infection Control and Hospital Epidemiology, 19(1), 9-16. https://doi.org/10.2307/30141350

The Epidemiology of Hemorrhage Related to Cardiothoracic Operations. / Herwaldt, Loreen A.; Swartzendruber, Sheri K.; Edmond, Michael B.; Embrey, Richard P.; Wilkerson, Kim R.; Wenzel, Richard P.; Perl, Trish M.

In: Infection Control and Hospital Epidemiology, Vol. 19, No. 1, 01.01.1998, p. 9-16.

Research output: Contribution to journalArticle

Herwaldt, LA, Swartzendruber, SK, Edmond, MB, Embrey, RP, Wilkerson, KR, Wenzel, RP & Perl, TM 1998, 'The Epidemiology of Hemorrhage Related to Cardiothoracic Operations', Infection Control and Hospital Epidemiology, vol. 19, no. 1, pp. 9-16. https://doi.org/10.2307/30141350
Herwaldt LA, Swartzendruber SK, Edmond MB, Embrey RP, Wilkerson KR, Wenzel RP et al. The Epidemiology of Hemorrhage Related to Cardiothoracic Operations. Infection Control and Hospital Epidemiology. 1998 Jan 1;19(1):9-16. https://doi.org/10.2307/30141350
Herwaldt, Loreen A. ; Swartzendruber, Sheri K. ; Edmond, Michael B. ; Embrey, Richard P. ; Wilkerson, Kim R. ; Wenzel, Richard P. ; Perl, Trish M. / The Epidemiology of Hemorrhage Related to Cardiothoracic Operations. In: Infection Control and Hospital Epidemiology. 1998 ; Vol. 19, No. 1. pp. 9-16.
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