Abstract 4771: Reoperation for Bleeding among 528,279 Patients Undergoing Coronary Artery Bypass Surgery: The Society of Thoracic Surgeons National Database Experience
Patients (pts) undergoing coronary artery bypass surgery (CABG) have increasing risk profile in recent years. Additionally, these high-risk pts are often on potent antiplatelet therapies that increase bleeding risks. However, few studies have characterized clinical features and outcomes of CABG pts who need reoperation for bleeding (RB) in contemporary community practice. We evaluated data of 528,279 CABG pts at >800 hospitals in the Society of Thoracic Surgeons National Cardiac Database (2004 – 2007). Clinical features and hospital outcomes were studied in pts requiring vs. those not needing RB. A total of 12,644 pts (2.4%) needed RB after CABG with a modest increase over time (2.2%, 2.3%, 2.5%, 2.4% from 2004 to 2007, respectively; p for trend .0018). These pts were older with higher comorbidities and greater frequency of urgent, emergent or salvage surgery compared with those not needing RB. These pts were also more likely to have received thienopyrines and/or GP IIb/IIIa <24 hrs prior to CABG. In-hospital events and length of stay (7 vs. 5 days) were significantly higher in pts needing RB. Operative mortality was 4.5 fold higher in pts requiring RB versus those who did not need this but declined over time (Fig⇓). Reoperation for bleeding is an important and increasing complication of CABG that is associated with greater resource utilization and high mortality. Fortunately, death in pts needing RB is decreasing over time. Ongoing quality improvement effort through initiatives like the Society of Thoracic Surgery National Cardiac Surgeons Database are needed to further reduce this complication in the hope of improving outcomes after CABG.