title: Individual surgeon's impact on the risk of re-exploration for excessive bleeding after coronary artery bypass surgery.
abstract: OBJECTIVE
  Excessive bleeding requiring re-exploration is a severe complication that may affect the outcome after coronary artery bypass grafting. The authors hypothesized that surgeon performance may contribute significantly to such a complication.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Tertiary referral center in a university hospital.
  
  
  METHODS
  Two thousand one patients.
  
  
  METHODS
  Isolated coronary artery bypass grafting.
  
  
  RESULTS
  Re-exploration for bleeding was performed in 113 patients (5.3%). Re-exploration was performed ≥3 days after surgery in 11 patients. The surgical site of bleeding was identified in 83 patients (73.5%). Rates of re-exploration for excessive bleeding ranged from 1.4% to 11.7% according to different surgeons (p < 0.0001). When adjusted for the additive European System for Cardiac Operative Risk Evaluation, re-exploration for bleeding was associated with increased risks of low-cardiac-output syndrome (odds ratio [OR] 2.239, 95% confidence interval [CI] 1.328-3.777), prolonged need for inotropes (OR 1.894, 95% CI 1.198-2.994), and an intensive care unit stay ≥5 days (OR 2.129, 95% CI 1.202-3.770). Logistic regression showed that an individual surgeon (p < 0.0001), preoperative body mass index <25 kg/m(2) (OR 2.733, 95% CI 2.145-3.481), and estimated glomerular filtration rate <30 mL/min/1.73 m(2) (OR 3.891, 95% CI 1.669-9.076) were independent predictors of re-exploration for excessive bleeding. An individual surgeon also was an independent predictor of a postoperative blood loss ≥1,600 mL.
  
  
  CONCLUSIONS
  An individual surgeon has a major impact on postoperative bleeding, and a meticulous surgical technique is expected to decrease significantly such a severe complication.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Reija
authors.initials: R
authors.lastname: Mikkola
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: Ulla
authors.initials: U
authors.lastname: Kettunen
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk