Trends in rates of reexploration for hemorrhage after coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.
BACKGROUND
While mortality rates associated with coronary artery bypass grafting (CABG) have been declining, it is unknown whether similar improvements in the rates of morbidity have been occurring. This study examines trends in reexploration rates for hemorrhage, one of the serious complications of CABG surgery. It also explores changes in patient characteristics and several surgeon practice patterns potentially related to bleeding risks that may explain variations in these rates.


METHODS
We performed a regional observational study of all of the 12,555 consecutive patients undergoing isolated CABG surgery in northern New England between 1992 and 1997. The rates of reexploration and patient characteristics were examined between two time intervals: period I (January 1, 1992 to June 1, 1994) and period II (June 1, 1995 to March 31, 1997). All of the region's 23 practicing surgeons responsible for these patients were surveyed to assess changes in practice patterns potentially related to bleeding risks.


RESULTS
The adjusted rates of reexploration for bleeding declined 46% between periods I and II (3.6% versus 2.0%, p < 0.001). All of the five cardiac centers in northern New England showed similar trends with adjusted risk reductions ranging from 32% to 48% between the two time periods. This decline occurred despite the patients in period II having higher percentages of risk factors for reexploration for bleeding compared to patients in period I. From the surgeon survey, the number of surgeons using antifibrinolytics markedly increased from period I to period II. More surgeons were also using preoperative aspirin and heparin up until the time of surgery in period II.


CONCLUSIONS
Similar to the rates of mortality, the rates of reexploration for bleeding following CABG surgery are substantially declining. This decrease in the reexploration rates occurred despite higher patient risks.
Munoz
J J
JJ
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. john.j.munoz@hitchcock.org
Birkmeyer
N J
NJ
Dacey
L J
LJ
Birkmeyer
J D
JD
Charlesworth
D C
DC
Johnson
E R
ER
Lahey
S J
SJ
Norotsky
M
M
Quinn
R D
RD
Westbrook
B M
BM
O'Connor
G T
GT
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England; D019106:Postoperative Hemorrhage / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000639:trends; D012086:Reoperation / Q000639:trends; D012307:Risk Factors