title: Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study.
abstract: Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated.
  
  
  
  To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding.
  
  
  
  This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients' charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and speciﬁcity.
  
  
  
  The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%.
  
  
  
  Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding.
authors.affiliation: Paulista Nursing School, Federal University of Sao Paulo (EPE-UNIFESP), Brazil camilatakao@hotmail.com.
authors.forename: Camila T
authors.initials: CT
authors.lastname: Lopes
authors.affiliation: Paulista Nursing School, Federal University of Sao Paulo (EPE-UNIFESP), Brazil.
authors.forename: Evelise H Fadini Reis
authors.initials: EH
authors.lastname: Brunori
authors.affiliation: Paulista Nursing School, Federal University of Sao Paulo (EPE-UNIFESP), Brazil.
authors.forename: Vinicius Batista
authors.initials: VB
authors.lastname: Santos
authors.affiliation: University of Iowa, Iowa City, USA.
authors.forename: Sue A
authors.initials: SA
authors.lastname: Moorhead
authors.affiliation: Paulista Nursing School, Federal University of Sao Paulo (EPE-UNIFESP), Brazil.
authors.forename: Juliana de Lima
authors.initials: Jde L
authors.lastname: Lopes
authors.affiliation: Paulista Nursing School, Federal University of Sao Paulo (EPE-UNIFESP), Brazil.
authors.forename: Alba L Bottura Leite
authors.initials: AL
authors.lastname: de Barros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: Cardiac surgery; cardiac surgical procedures; postoperative hemorrhage; reoperation; risk factors