title: Retained Blood Syndrome After Cardiac Surgery: A New Look at an Old Problem.
abstract: Retained blood occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. As a result, a spectrum of mechanical and inflammatory complications can ensue in the acute, subacute, and chronic setting. The objectives of this review were to define the clinical syndrome associated with retained blood over the spectrum of recovery and to review existing literature regarding how this may lead to complications and contributes to poor outcomes. To better understand and prevent this constellation of clinical complications, a literature review was conducted, which led us to create a new label that better defines the clinical entity we have titled retained blood syndrome. Analysis of published reports revealed that 13.8% to 22.7% of cardiac surgical patients develop one or more components of retained blood syndrome. This can present in the acute, subacute, or chronic setting, with different pathophysiologic mechanisms active at different times. The development of retained blood syndrome has been linked to other clinical outcomes, including the development of postoperative atrial fibrillation and infection and the need for hospital readmission. Grouping multiple objectively measurable and potentially preventable postoperative complications that share a common etiology of retained blood over the continuum of recovery demonstrates a high prevalence of retained blood syndrome. This suggests the need to develop, implement, and test clinical strategies to enhance surgical drainage and reduce postoperative complications in patients undergoing cardiothoracic surgery.
authors.affiliation: From the *Department of Thoracic Surgery, St. Charles Medical Center, Bend, OR USA; †Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH USA; ‡Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX USA; §Department of Nursing, California Pacific Medical Center, San Francisco, CA USA; ∥Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany; and ¶Department of Surgery, Montreal Heart Institute, Montreal, QC Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Boyle
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.forename: S Jill
authors.initials: SJ
authors.lastname: Ley
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
mesh_terms: D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D013577:Syndrome; D017211:Treatment Failure