title: Managing port-site bleeding during less invasive coronary artery bypass grafting.
abstract: BACKGROUND
  Robotic-assisted coronary artery bypass grafting (r-CABG) requires the placement of ports bluntly through the chest wall. When removed, these ports create bleeding sites that can be difficult to detect and treat. This study evaluated whether a topical hemostatic agent placed locally within these sites helps to reduce bleeding and blood product requirements.
  
  
  METHODS
  We retrospectively analyzed outcomes for r-CABG cases where 5 mL of a flowable hemostatic agent was injected locally within all port sites (hemostat group, n = 62) compared with patients whose port sites were untreated (controls, n = 131). Outcomes included chest tube output, red blood cell (RBC) transfusions, length of hospital stay, and the risk of reoperation for bleeding. Analyses were adjusted for risk factors known to influence bleeding and Society of Thoracic Surgeons (STS) risk score as a weighted composite of variables, which controls for patient and clinical variables.
  
  
  RESULTS
  The 2 study groups had similar baseline characteristics and underwent the same r-CABG procedure. The hemostat group had significant reductions in RBC transfusion (24.2% versus 40.8% receiving blood; P = .026; 0.44 versus 1.39 U transfused postoperatively, P = .024). After adjustment for bleeding risks (using STS risk score), differences in transfusions remained significant. Reoperation rates for bleeding, length of stay, chest tube drainage, and intraoperative transfusions were not significantly different in the 2 groups.
  
  
  CONCLUSIONS
  There was significantly reduced postoperative bleeding and less exposure to blood products in the hemostat group. These findings suggest that undetected bleeding from sites used for port access serves as an underappreciated source of morbidity after r-CABG.
authors.affiliation: Division of Cardiothoracic Surgery, University of Arizona School of Medicine, Tucson, AZ 85724-5071, USA.
authors.forename: Soroosh
authors.initials: S
authors.lastname: Kiani
authors.forename: Mary-Lynn
authors.initials: ML
authors.lastname: Brecht
authors.forename: Katherine
authors.initials: K
authors.lastname: Lovinger
authors.forename: Robert S
authors.initials: RS
authors.lastname: Poston
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015505:Chest Tubes; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004322:Drainage / Q000379:methods; D017707:Erythrocyte Transfusion / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*
chemical_list: D006490:Hemostatics