title: Hemorrhage after coronary artery bypass graft procedures.
abstract: OBJECTIVE
  To identify risk factors for excessive bleeding after coronary artery bypass graft (CABG) procedures and to quantify the outcomes related to this complication.
  
  
  METHODS
  We conducted a case-control study to identify risk factors for hemorrhage following CABG surgery and a historical cohort study to quantify outcomes of hemorrhage.
  
  
  METHODS
  The cardiothoracic surgery service of a university hospital.
  
  
  RESULTS
  Factors associated with excessive blood loss were recent catheterization (odds ratio [OR] = 0.44; 95% confidence interval [CI95], 0.21 to 0.91); age older than 65 years (OR = 1.94; CI95, 0.96 to 3.93); bypass time of 150 minutes or more (OR = 2.91; CI95, 1.09 to 7.81); and postoperative platelet count of 160,000/mm3 or less (OR = 2.36; CI95, 1.06 to 5.22). The attributable cost of a postoperative hemorrhage was $3,866 (P = .0002) overall, $9,912 (P = .0001) for patients who required reoperation, and $3,316 (P = .03) for those treated medically. The median attributable postoperative length of stay was 1 day longer for cases than for controls (P = .011). Postoperatively, patients who hemorrhaged received significantly larger volumes of packed red blood cells (P < .0001), fresh frozen plasma (P < .0001), platelets (P < .0001), plasminate (P = .007), protamine sulfate (P < .0001), desmopressin acetate (P < .0001), and epsilon-aminocaproic acid (P < .0001) than did controls.
  
  
  CONCLUSIONS
  Age, duration of bypass, and postoperative platelet count were associated with excessive bleeding. Hemorrhage after CABG surgery significantly increased the length of stay and cost of care.
authors.affiliation: Department of Internal Medicine, University of Iowa College of Medicine, USA.
authors.forename: Loreen A
authors.initials: LA
authors.lastname: Herwaldt
authors.forename: Sheri K
authors.initials: SK
authors.lastname: Swartzendruber
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: David A
authors.initials: DA
authors.lastname: Scholz
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Franklin
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000191:economics / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors