Rachel S Bercovitz1, Allison C Shewmake2, Debra K Newman3, Robert A Niebler4, John P Scott5, Eckehard Stuth6, Pippa M Simpson7, Ke Yan8, Ronald K Woods9. 1. Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wis; Division of Hematology and Oncology, Departments of Pathology, Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wis. Electronic address: rbercovitz@luriechildrens.org. 2. School of Medicine, Medical College of Wisconsin, Milwaukee, Wis. 3. Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wis; Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, Wis. 4. Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis. 5. Division of Pediatric Anesthesia, Department of Anesthesia, Medical College of Wisconsin, Milwaukee, Wis; Division of Quantitative Health Sciences of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis. 6. Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Pediatric Anesthesia, Department of Anesthesia, Medical College of Wisconsin, Milwaukee, Wis. 7. Division of Quantitative Health Sciences of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis. 8. Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wis. 9. Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis; Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
Abstract
OBJECTIVE: To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates. RESULTS: Excessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period. CONCLUSIONS: The proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives.
OBJECTIVE: To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission. After the definition of excessive bleeding was determined, it was validated via a prospective cohort of 77 infants and neonates. RESULTS:Excessive bleeding was defined as ≥7 mL/kg/h for ≥2 consecutive hours in the first 12 postoperative hours and/or ≥84 mL/kg total for the first 24 postoperative hours and/or surgical re-exploration for bleeding or cardiac tamponade physiology in the first 24 postoperative hours. Excessive bleeding was associated with longer length of hospital stay, increased 30-day readmission rate, and increased transfusions in the postoperative period. CONCLUSIONS: The proposed standard definition of excessive bleeding is based on readily obtained objective data and relates to important early clinical outcomes. Application and validation by other institutions will help determine the extent to which our specialty should consider this definition for both clinical investigation and quality improvement initiatives.
Authors: Marianne E Nellis; Marisa Tucci; Jacques Lacroix; Philip C Spinella; Kelly D Haque; Arabela Stock; Marie E Steiner; E Vincent S Faustino; Nicole D Zantek; Peter J Davis; Simon J Stanworth; Jill M Cholette; Robert I Parker; Pierre Demaret; Martin C J Kneyber; Robert T Russell; Paul A Stricker; Adam M Vogel; Ariane Willems; Cassandra D Josephson; Naomi L C Luban; Laura L Loftis; Stéphane Leteurtre; Christian F Stocker; Susan M Goobie; Oliver Karam Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598
Authors: Nicole M J Zwifelhofer; Rachel S Bercovitz; Regina Cole; Ke Yan; Pippa M Simpson; Alyssa Moroi; Peter J Newman; Robert A Niebler; John P Scott; Eckehard A D Stuth; Ronald K Woods; D Woodrow Benson; Debra K Newman Journal: Thromb Haemost Date: 2019-11-21 Impact factor: 5.249
Authors: Susan A Maroney; Julie A Peterson; Wes Zwifelhofer; Nicholas D Martinez; Ke Yan; Rachel S Bercovitz; Ronald K Woods; Alan E Mast Journal: Thromb Haemost Date: 2018-08-07 Impact factor: 5.249
Authors: J A Peterson; S A Maroney; W Zwifelhofer; J P Wood; K Yan; R S Bercovitz; R K Woods; A E Mast Journal: J Thromb Haemost Date: 2018-08-16 Impact factor: 5.824