title: Risk Factors Associated with Reoperation for Bleeding following Liver Transplantation.
abstract: Introduction. This study's objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx). Methods. A retrospective study was performed at a single institution between 2001 and 2012. Operative reports were used to identify patients who underwent reoperation for bleeding within 2 weeks following LTx (operations for nonbleeding etiologies were excluded). Results. Reoperation for bleeding was observed in 101/928 (10.8%) of LTx patients. The following characteristics were associated with reoperation on multivariable analysis: recipient MELD score (OR 1.06/MELD unit, 95% CI 1.03, 1.09), number of platelets transfused (OR 0.73/platelet unit, 95% CI 0.58, 0.91), and aminocaproic acid utilization (OR 0.46, 95% CI 0.27, 0.80). LTx patients who underwent reoperation for bleeding had a longer ICU stay (5 days ± 7 versus 2 days ± 3, P < 0.001) and hospitalization (18 days ± 9 versus 10 days ± 18, P < 0.001). The risk of death increased in patients who underwent reoperation for bleeding (HR 1.89, 95% CI 1.26, 2.85). Conclusion. Reoperation for bleeding following LTx was associated with increased resource utilization and recipient mortality. A lower threshold for intraoperative platelet transfusion and antifibrinolytics, especially in patients with high lab-MELD score, may decrease the incidence of reoperation for bleeding following LTx.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Maxwell A
authors.initials: MA
authors.lastname: Thompson
authors.affiliation: Biostatistics Division, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Glueckert
authors.affiliation: Department of Anesthesia, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: A Blair
authors.initials: AB
authors.lastname: Smith
authors.affiliation: Department of Anesthesia, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Jack H
authors.initials: JH
authors.lastname: Crawford
authors.affiliation: Department of Anesthesia, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Jones
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, 701 ZRB, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA.
authors.forename: Devin E
authors.initials: DE
authors.lastname: Eckhoff
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, 701 ZRB, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gray
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, 701 ZRB, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA.
authors.forename: Jared A
authors.initials: JA
authors.lastname: White
authors.affiliation: Transplant Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bloomer
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, 701 ZRB, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay