Coagulopathy After Cardiac Surgery
Hospital Universitario de Canarias, San Cristóbal de La Laguna, Canary Islands, SpainAnesthesia and analgesia (Impact Factor: 3.47). 12/2007; 105(5):1514; author reply 1514-5. DOI: 10.1213/01.ane.0000282775.38626.13
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Article: Coagulopathy After Cardiac Surgery
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ABSTRACT: Extreme position changes, electrolyte changes, presence of comorbidities such as obstructive sleep apnea, long and complex surgeries, bleeding risks, and an elderly population combine together to increase the risk of perioperative complications during urologic procedures. Not uncommonly these complications may be rightly or wrongly interpreted as malpractice, and the case becomes entrenched in the medicolegal system. Understanding this system and developing strategies to avoid poor or even catastrophic outcomes are essential to the entire urologic team. © Springer Science+Business Media New York 2014. All rights are reserved.
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ABSTRACT: Background The prevalence and contemporary trends of pre–heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.HypothesisPre-HT coagulopathy is associated with increased in-hospital mortality.Methods Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics.ResultsThe prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54–2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008).Conclusions In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.