title: Early postoperative bleeding is independently associated with increased surgical mortality in infants after cardiopulmonary bypass.
abstract: OBJECTIVE
  Infants undergoing cardiac surgery often have postoperative bleeding contributing to the occurrence of adverse events. A quantitative evaluation of postoperative bleeding has not been well described.
  
  
  METHODS
  We identified 1071 infants who had undergone cardiopulmonary bypass from August 1, 2008 to December 31, 2011. The volume of postoperative bleeding and its effect on mortality were reviewed.
  
  
  RESULTS
  Postoperative bleeding during the first 12 hours postoperatively was stratified by quartiles. Bleeding was significantly associated with increased mortality (odds ratio [OR], 1.15; 95% confidence interval [CI] 1.10-1.21; P < .001). Other risk factors significantly associated with mortality included greater Risk Adjustment for Congenital Heart Surgery score (OR, 1.5; 95% CI, 1.22-1.85; P < .001), single ventricle anatomy (OR, 3.09; 95% CI, 1.68-5.67; P < .001), younger age (OR, 0.99; 95% CI, 0.98-0.99; P < .001), and longer perfusion time (OR, 1.01; 95% CI, 1.01-1.02; P < .001). Subjects with greater bleeding volumes experienced a longer postoperative mechanical ventilation and intensive care unit stay. The overall hospital mortality was 4.1%. On multivariate analysis, adjusting for age, single ventricle anatomy, Risk Adjustment for Congenital Heart Surgery score, and perfusion time, an increasing bleeding volume was independently associated with increased mortality. Packed red blood cell transfusion was independently associated with an increased duration of mechanical ventilation (P = .01) and intensive care unit length of stay (P = .003).
  
  
  CONCLUSIONS
  Early postoperative hemorrhage was independently associated with an increased mortality in infants after cardiac surgery. The longer interval from surgery to death suggests that other factors, aside from the bleeding itself, including the transfusion volume, might contribute to mortality. Initiatives to limit postoperative bleeding and to critically appraise packed red blood cell transfusion practices are warranted.
authors: Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga. Electronic address: wolfm@kidsheart.com.
authors: Michael J
authors: MJ
authors: Wolf
authors: Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.
authors: Kevin O
authors: KO
authors: Maher
authors: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
authors: Kirk R
authors: KR
authors: Kanter
authors: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
authors: Brian E
authors: BE
authors: Kogon
authors: Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Emory University School of Medicine, Atlanta, Ga.
authors: Nina A
authors: NA
authors: Guzzetta
authors: Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.
authors: William T
authors: WT
authors: Mahle
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D017707:Erythrocyte Transfusion / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome