Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
THE EPIDEMIOLOGY OF HEMORRHAGE RELATED TO CARDIOTHORACIC OPERATIONS
Autore:
HERWALDT LA; SWARTZENDRUBER SK; EDMOND MB; EMBREY RP; WILKERSON KR; WENZEL RP; PERL TM;
Indirizzi:
UNIV IOWA HOSP & CLIN,DEPT INTERNAL MED,200 HAWKINS DR IOWA CITY IA 52242 UNIV IOWA,COLL MED,DEPT INTERNAL MED IOWA CITY IA 52242 UNIV IOWA,COLL MED,DEPT SURG IOWA CITY IA 52242 VET ADM MED CTR IOWA CITY IA 00000
Titolo Testata:
Infection control and hospital epidemiology
fascicolo: 1, volume: 19, anno: 1998,
pagine: 9 - 16
SICI:
0899-823X(1998)19:1<9:TEOHRT>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
OPEN-HEART-SURGERY; ARTERY BYPASS OPERATIONS; REDUCE BLOOD-LOSS; CARDIOPULMONARY BYPASS; CORONARY-ARTERY; HYDROXYETHYL STARCH; CARDIAC-SURGERY; POSTOPERATIVE COMPLICATIONS; EXTRACORPOREAL-CIRCULATION; PLATELET DYSFUNCTION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
39
Recensione:
Indirizzi per estratti:
Citazione:
L.A. Herwaldt et al., "THE EPIDEMIOLOGY OF HEMORRHAGE RELATED TO CARDIOTHORACIC OPERATIONS", Infection control and hospital epidemiology, 19(1), 1998, pp. 9-16

Abstract

OBJECTIVE: To define the epidemiology, risk factors, and unadjusted cost of hemorrhages related to cardiothoracic operations. STUDY DESIGN:We conducted two case-control studies to evaluate the risk of hemorrhage following cardiothoracic operations. The definition of hemorrhage required one of the following: reoperation for bleeding, postoperativeloss of greater than 800 mL of blood over 4 hours, or surgeon-diagnosed excessive intraoperative bleeding. SETTING: The cardiothoracic surgery service of a university hospital. RESULTS: Of 511 patients undergoing cardiothoracic operations, 93 (18%) met the definition of hemorrhage. In the first case-control study, 3 (14%) of 21 cases and 0 of 42 controls died (odds ratio [OR], 15.0; 95% confidence interval [CI95], 1.18-191.55). Compared with controls, cases received significantly morepacked red blood cells intraoperatively (OR 1.18/100 mL; CI95, 1.01-1.38), and significantly more platelets (OR, 3.26/100 mL; CI95, 1.47-7.26) and fresh frozen plasma (OR 1.73/100 mL; CI95 1.05-.84) in the intensive-care unit. Cases were more likely than controls to receive protamine postoperatively (OR, 3.74; CI95, 1.27-11.02). Previous sternotomy, preoperative aspirin or heparin, and preoperative laboratory valuesdid not predict bleeding. The median unadjusted hospital cost was $3,458 higher for patients who suffered hemorrhage than for controls. To decrease costs, hetastarch (acquisition cost $45/500 mL) was substituted for albumin (acquisition cost $76/100 mL) in the pump priming solution (estimated possible cost savings, $7,000-$53,000/year). Because hemorrhage rates increased subsequently, we conducted a second case-control study that identified patient age (P=.02) and use of greater than 5 mL/kg of hetastarch (OR, 1.82) as risk factors for hemorrhage. The cost of treating hemorrhages exceeded all estimates of possible cost savings ($7,000-$53,000 per year). CONCLUSIONS: Our definition of hemorrhage identified patients who required increased volumes of blood products and who had an increased crude mortality rate and a higher unadjusted cost of hospitalization. Patient age and hetastarch use were risk factors for hemorrhage. Efforts to save money by substituting less expensive products inadvertently may increase costs by increasing the probability of perioperative adverse events.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/12/20 alle ore 08:24:34