Czynniki ryzyka zwiększonego drenażu klatki piersiowej u pacjentów poddawanych operacji pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego
| Autor: | Wojciech Szychta, Grzegorz Opolski, Franciszek Majstrak, Krzysztof J. Filipiak |
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| Rok vydání: | 2016 |
| Předmět: | |
| Zdroj: | Folia Cardiologica. 11:19-25 |
| ISSN: | 2353-7760 2353-7752 |
| DOI: | 10.5603/fc.2016.0003 |
| Popis: | Introduction. The aim of the study is to identify risk factors of increased postoperative bleeding after off-pump surgical treatment of coronary artery disease (OPCAB). Material and methods. A retrospective study including all patients undergoing OPCAB (2004–2008) at a single-center institution, who were analyzed with statistical methods to find risk factors increasing postoperative bleeding. Statistical significance was determined at the level of p < 0.05. Results. One thousand two hundred and fifty-three patients aged 65.5 ± 9.6 were enrolled into the study. The average amount of drained blood on the first day after the surgery was 716.74 ± 430.12 mL. Seventy-six patients (6%) underwent surgical re-exploration due to postoperative bleeding. Factors elevating mediastinal drainage on the first day after the surgery included: advanced coronary artery disease, administration of clopidogrel at least 5 days before surgery and arterial grafts. Patients also had a higher mediastinal drainage when grafted: left internal mammary artery (LIMA), LIMA and right internal mammary artery (RIMA) as well as LIMA and left radial artery (LRA) (p < 0.001). Factors elevating mediastinal drainage were: lower body mass index (BMI) (according to World Health Organization groups) of operated patients (p = 0.023), even lower value of the additive EuroScore (p < 0.001) and logistical EuroScore (p = 0.001), longer duration of operations (p < 0.001) and increasing number of grafts (p < 0.001). When analyzed according to deciles of BMI and body surface area, the higher drainage was found, the higher decile of BMI was noted (p < 0.0001), but the lower drainage was found, the higher decile of BSA was noted (p < 0.0001). Finally, no differences were found between deciles 2 and 3, 3 and 4, 4 and 5, 5 and 6, 6 and 7 and the results were similar to non-indexed values (p < 0.001). The overall regression model showed that patients who had greater amounts of blood drained had: lower value of BMI (p < 0.001), received clopidogrel more often (p < 0.001), grafted bilateral internal mammary arteries (BIMA) (p < 0.001) and longer lasting operation (p < 0.001). Conclusions. Our results suggest that overweight and obese patients have a significantly lower risk of elevated blood drainage. Lost blood should be probably considered an indexed parameter, however our observation needs further evaluation. Surgeons should pay special attention to patients with diabetes, patients with multivessel disease and those who had BIMA used as grafts. |
| Databáze: | OpenAIRE |
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