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Post-operative blood loss is higher among African American neonates undergoing open-heart surgery with cardiopulmonary bypass for CHD

Published online by Cambridge University Press:  06 December 2019

Vyas M. Kartha Open the ORCID record for Vyas M. Kartha [Opens in a new window] ,
Mohamed Rehman ,
Anh Thy H. Nguyen ,
Ernest Amankwah ,
Erica M.S. Sibinga ,
Neil A. Goldenberg  and
Jeffrey P. Jacobs
Vyas M. Kartha*
Affiliation:
Department of Anesthesiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL, USA
Mohamed Rehman
Affiliation:
Department of Anesthesiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Anh Thy H. Nguyen
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
Ernest Amankwah
Affiliation:
Health Informatics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA Department of Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA Johns Hopkins All Children’s Cancer and Blood Disorders Institute, Saint Petersburg, FL, USA
Erica M.S. Sibinga
Affiliation:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Neil A. Goldenberg
Affiliation:
Johns Hopkins All Children’s Cancer and Blood Disorders Institute, Saint Petersburg, FL, USA Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins All Children’s Clinical and Translational Research Organization, All Children’s Research Institute, Saint Petersburg, FL, USA Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins All Children’s Heart Institute, Saint Petersburg, FL, USA Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
*
Author for correspondence: Dr V. Kartha, Department of Anesthesiology, Johns Hopkins All Children’s Hospital, 501 6th Avenue South, Saint Petersburg, FL 33701, USA. Tel: (727) 767-3583; Fax: (727) 767-8429. E-mail: Vkatha1@jhmi.edu
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Abstract

Background:

Neonates are at high risk of bleeding after open-heart surgery. We sought to determine pre-operative and intra-operative risk factors for increased bleeding after neonatal open-heart surgery with cardiopulmonary bypass.

Methods:

We conducted a retrospective cohort study of neonates (0–30 days old) who underwent open-heart surgery with cardiopulmonary bypass from January, 2009, to March, 2013. Cardiac diagnosis; demographic and surgical data; and blood products, haemostatic agents, and anti-thrombotic agents administered before, during, and within 24 hours after surgery were abstracted from the electronic health record and anaesthesia records. The outcome of interest was chest tube output (in ml/kg body weight) within 24 hours. Relationships between chest tube output and putative associated factors were evaluated by unadjusted and adjusted linear regression.

Results:

The cohort consisted of 107 neonates, of whom 79% had a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Category of 4 or 5. Median chest tube output was 37 ml/kg (range 9–655 ml/kg). Age, African-American race, and longer durations of surgery and cardiopulmonary bypass each had statistically significant associations with increased chest tube output in unadjusted analyses. In multivariable analysis, African-American race retained an independent, statistically significant association with increased chest tube output; the geometric mean of chest tube output among African-American neonates was 71% higher than that of Caucasians (95% confidence interval, 29–125%; p = 0.001).

Conclusion:

Among neonates with CHD undergoing open-heart surgery with cardiopulmonary bypass, African-American race is independently associated with greater chest tube output over the first 24 hours post-operatively.

Keywords

BleedingCHDneonateopen-heart surgerycardiopulmonary bypass
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 74 - 81
Copyright
© Cambridge University Press 2019

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Footnotes

*

In neonates undergoing open-heart surgery, numerous factors influence post-operative blood loss. Previous studies have identified prematurity, lower weight, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and longer regional perfusion time or circulatory arrest time to be potentially prognostic.

In this single-centre retrospective cohort study of over 100 neonates undergoing open-heart surgery with cardiopulmonary bypass, after adjustment for other factors, African American race was independently associated with increased post-operative blood loss.

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