title: Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients.
abstract: Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low-risk patients undergoing coronary artery bypass grafting (CABG).
  
  
  
  Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E-CABG). The severity of bleeding was defined by the E-CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification.
  
  
  
  Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E-CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E-CABG bleeding Grade 2-3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E-CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding.
  
  
  
  Severe bleeding is rather uncommon in low-risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low-risk patients.
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Eeva-Maija
authors: EM
authors: Kinnunen
authors: Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors: Marisa
authors: M
authors: De Feo
authors: Hamburg University Heart Center, Hamburg, Germany.
authors: Daniel
authors: D
authors: Reichart
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Tuomas
authors: T
authors: Tauriainen
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Giuseppe
authors: G
authors: Gatti
authors: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors: Francesco
authors: F
authors: Onorati
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Luca
authors: L
authors: Maschietto
authors: Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors: Ciro
authors: C
authors: Bancone
authors: Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors: Francesca
authors: F
authors: Fiorentino
authors: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors: Sidney
authors: S
authors: Chocron
authors: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors: Karl
authors: K
authors: Bounader
authors: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Magnus
authors: M
authors: Dalén
authors: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Peter
authors: P
authors: Svenarud
authors: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors: Giuseppe
authors: G
authors: Faggian
authors: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors: Ilaria
authors: I
authors: Franzese
authors: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors: Theodor
authors: T
authors: Fischlein
authors: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors: Daniele
authors: D
authors: Maselli
authors: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors: Carmelo
authors: C
authors: Dominici
authors: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors: Saverio
authors: S
authors: Nardella
authors: Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
authors: Riccardo
authors: R
authors: Gherli
authors: Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy.
authors: Francesco
authors: F
authors: Musumeci
authors: Centro Cuore Morgagni, Pedara, Italy.
authors: Antonino S
authors: AS
authors: Rubino
authors: Centro Cuore Morgagni, Pedara, Italy.
authors: Carmelo
authors: C
authors: Mignosa
authors: Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK.
authors: Giovanni
authors: G
authors: Mariscalco
authors: Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK.
authors: Filiberto G
authors: FG
authors: Serraino
authors: Division of Cardiac Surgery, University of Genoa, Genoa, Italy.
authors: Francesco
authors: F
authors: Santini
authors: Division of Cardiac Surgery, University of Genoa, Genoa, Italy.
authors: Antonio
authors: A
authors: Salsano
authors: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors: Francesco
authors: F
authors: Nicolini
authors: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors: Tiziano
authors: T
authors: Gherli
authors: Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy.
authors: Marco
authors: M
authors: Zanobini
authors: Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy.
authors: Matteo
authors: M
authors: Saccocci
authors: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors: Vito G
authors: VG
authors: Ruggieri
authors: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors: Jean
authors: J
authors: Philippe Verhoye
authors: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors: Andrea
authors: A
authors: Perrotti
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D062606:Tertiary Care Centers