Mehta Rajendra H, Sheng Shubin, O'Brien Sean M, Grover Frederick L, Gammie James S, Ferguson T Bruce, Peterson Eric D
Duke Clinical Research Institute, Durham, NC 27715, USA.
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):583-90. doi: 10.1161/CIRCOUTCOMES.109.858811. Epub 2009 Oct 6.
Reoperation for bleeding represents an important complication in patients undergoing coronary artery bypass surgery (CABG). Yet, few studies have characterized risk factors and patient outcomes of this event.
We evaluated 528 686 CABG patients at >800 hospitals in the Society of Thoracic Surgeons National Cardiac Database (2004 to 2007). Clinical features and in-hospital outcomes were evaluated in patients with and without reoperation for bleeding after CABG. Logistic regression was used to identify predictors of risk of this event and to estimate weights for an additive risk score. A total of 12 652 CABG patients (2.4%) required reoperation for bleeding. These rates remained fairly stable over time (2.2%, 2.3%, 2.5%, and 2.4% from 2004 to 2007, respectively). Although overall operative mortality was 4.5-fold higher in patients requiring reoperation for bleeding versus those who did not (2.0% versus 9.1%), this mortality risk declined significantly over time (11.3%, 9.5%, 8.8%, and 8.2% from 2004 to 2007, respectively, P for trend=0.0006). Factors associated with higher risk for reoperation were identified by multivariable analysis (c statistic=0.60) and summarized into a simple bedside risk score. The risk-score performed well when tested in the validation set (Hosmer-Lemeshow P=0.16).
Reoperation for bleeding remains an important morbid event after CABG. Nonetheless, death in patients with this complication has decreased over time. Our risk tool should allow estimation of patients risk for reoperation for bleeding and promote preventive measures when feasible in this at-risk group.
冠状动脉搭桥手术（CABG）患者因出血进行再次手术是一种重要的并发症。然而，很少有研究对该事件的危险因素和患者预后进行描述。
我们在胸外科医师协会国家心脏数据库（2004年至2007年）中评估了800多家医院的528686例CABG患者。对CABG术后有或无因出血进行再次手术的患者的临床特征和住院结局进行了评估。采用逻辑回归来确定该事件风险的预测因素，并估计相加风险评分的权重。共有12652例CABG患者（2.4%）因出血需要再次手术。这些发生率随时间保持相当稳定（2004年至2007年分别为2.2%、2.3%、2.5%和2.4%）。尽管因出血需要再次手术的患者总体手术死亡率比不需要再次手术的患者高4.5倍（2.0%对9.1%），但这种死亡风险随时间显著下降（2004年至2007年分别为11.3%、9.5%、8.8%和8.2%，趋势P=0.0006）。通过多变量分析确定了与再次手术高风险相关的因素（c统计量=0.60），并汇总成一个简单的床边风险评分。该风险评分在验证集中进行测试时表现良好（Hosmer-Lemeshow P=0.16）。
CABG术后因出血进行再次手术仍然是一个重要的不良事件。尽管如此，这种并发症患者的死亡率随时间有所下降。我们的风险工具应能估计患者因出血进行再次手术的风险，并在该高危组可行时促进采取预防措施。
