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Anesth Analg 2006;102:1012-1017
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000198563.28246.00

CARDIOVASCULAR ANESTHESIA

Excessive Bleeding and Transfusion in a Prior Cardiac Surgery is Associated with Excessive Bleeding and Transfusion in the Next Surgery

Gregory A. Nuttall, MD*, Nicole Henderson, MS**, Michael Quinn, CRNA{dagger}, Clay Blair, CRNA{dagger}, Layne Summers, CRNA{dagger}, Brent A. Williams, MS{ddagger}, William C. Oliver, MD*, and Paula J. Santrach, MD***

Department of Anesthesilogy, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Gregory A. Nuttall, MD, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Address e-mail to nuttall.gregory{at}mayo.edu.

If there is a genetic predisposition to excessive bleeding, there should be an association in excessive blood loss between multiple cardiac surgeries. We retrospectively determined in 174 patients the association of excessive bleeding between 2 cardiac surgeries with cardiopulmonary bypass between January 19, 1990 and June 25, 2002. Excessive bleeding was defined by 2 criteria: (a) postoperating room chest tube blood loss over 24 h more than or equal to 750 mL (chest tube drainage [CTD] ≥ 750) and (b) transfusion of any non-red blood cell (RBC) blood products. Logistic regression was used to estimate the association between excessive bleeding at the first and second cardiac procedures. The logistic regression models for CTD ≥ 750 in the second surgery determined that CTD ≥ 750 in the first surgery compared to CTD < 750 had an unadjusted odds ratio of 2.18 (P = 0.03) and an odds ratio of 2.42 (P = 0.03) when adjusted for age, sex, body surface area, preoperative anticoagulant use, cardiopulmonary bypass duration, and procedure type at second surgery. The logistic regression model for any non-RBC use in the second surgery determined that any non-RBC use in the first surgery compared with no non-RBC use had an unadjusted odds ratio of 2.32 (P = 0.02) and an odds ratio of 2.55 (P = 0.02) when adjusted for age, sex, body surface area, preoperative anticoagulant use, cardiopulmonary bypass duration, and procedure type at second surgery. We conclude that a history of excessive bleeding during the first operation is associated with more than two times increased risk for excessive bleeding in the second surgery.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.