Objective This study was to investigate impact of massive bleeding on perioperative outcomes after cardiac surgery and to analyse the risk factors of massive bleeding. Method This was a retrospective study of 4,303 consecutive adult patients undergoing cardiac surgery or aortic surgery. All the patients were divided into massive bleeding group and control group. Massive postoperative bleeding was a composite outcome of bleeding from chest tubes that exceeded 1.5 liters during any 8-hour period or massive transfusion, which was defined as the administration of more than 10 units of red cells within 24 hours after surgery. We also included repeat surgery due to hemorrhage or cardiac tamponade starting within the first 24 hours after protamine administration and death from hemorrhage during the 30-day study period. Outcomes of the two groups were compared to study the impact of massive bleeding on perioperative mortality and major complications, and hospital stay and total costs. Multivariable logistic regression analysis was used to predict the risk factors of massive bleeding. Result In all, 4303 cases were enrolled, massive bleeding group (n=373, 8.7%) and control group (n=3930, 91.3%). The massive bleeding group had higher mortality (5.4% vs 0.3%, P=0.000) and renal, cardiac, neurological and pulmonary complications. The massive bleeding group also had a longer hospital stay and higher total hospitalization costs. Multivariable logistic regression analysis indicated that risk factors of massive bleeding included age, weight, LVEF, Creatinine, Emergency status, Repeat procedure, combined procedures , aortic surgery, CPB time and antifibrinolytic agent. Conclusion Postoperative massive bleeding could significantly increase perioperative mortality and major complications, and lead to longer hospital stay and higher hospitalization costs. Risk factor analysis may help to decrease postoperative bleeding and improve clinical outcomes.%目的 研究心脏外科术后严重出血对预后的影响及其可能的危险因素. 方法 回顾性分析4303例成人心血管外科手术患者,根据是否出现术后严重出血分为严重出血组和对照组.严重出血的定义为术后24小时内出血超过1500ml,或输入异体红细胞总量超过10U,或术后因出血而二次开胸(包括短期内大量出血或急性心包填塞),或术后30天内因出血引起的死亡.分析严重出血对住院死亡率、术后并发症发生率及住院时间和住院费用的影响,并通过多因素logistic回归分析探讨与术后严重出血相关的独立危险因素.结果 4303例患者中,严重出血组373例(8.7%),对照组3930例(91.3%).严重出血组住院死亡率显著高于对照组(5.4% vs 0.3%,P=0.000),术后严重并发症发生率(73.5%)、住院时间[(14.8±11.3)天]及住院费用[(10.6±7.1)万元]均明显高于对照组[分别为35.0%、(8.9±5.1)天、(5.5±2.7)万元],差异有显著性(P=0.000).多因素logistic回归分析显示,引起心脏外科术后严重出血的独立危险因素包括年龄、低体重、左心功能不全、血肌酐水平、急诊手术、二次手术、复合手术、主动脉手术、体外循环时间、术中应用纤溶酶抑制剂等. 结论 心脏外科术后严重出血可明显增加围术期死亡率及并发症发生率,增加住院时间及住院费用.可以通过有选择地控制危险因素,降低术后严重出血的发生率,改善术后结果.
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