Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England.
BACKGROUND: Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals.
METHODS: Retrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged >/=18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics.
RESULTS: The study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001).
CONCLUSIONS: Among English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery.
|ジャーナル名||Journal of cardiothoracic surgery|
|投稿者||Al-Attar, Nawwar; Johnston, Stephen; Jamous, Nadine; Mistry, Sameer; Ghosh, Ena; Gangoli, Gaurav; Danker, Walter; Etter, Katherine; Ammann, Eric|
|組織名||Department of Cardiac Surgery, Golden Jubilee National Hospital, University of;Glasgow, Agamemnon St, Clydebank G81 4DY, Glasgow, UK.;Nawwar.Alattar@gjnh.scot.nhs.uk.;Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA.;Health Economics & Market Access, Johnson & Johnson Medical Ltd, Berkshire, UK.;Medical Affairs, Johnson & Johnson Medical Ltd, Berkshire, UK.;Mu Sigma, Bangalore, India.;Health Economics & Market Access, Ethicon, Somerville, NJ, USA.|