Trends in rates of reexploration for hemorrhage after coronary artery bypass surgery

Background. While mortality rates associated with coronary artery bypass gr afting (CABG) have been declining, it is unknown whether similar improvemen ts in the rates of morbidity have been occurring. This study examines trend s in reexploration rates for hemorrhage, one of the serious complications o f CABG surgery. It also explores changes in patient characteristics and sev eral surgeon practice patterns potentially related to bleeding risks that m ay explain variations in these rates. Methods. We performed a regional observational study of all of the 12,555 c onsecutive patients undergoing isolated CABG surgery in northern New Englan d between 1992 and 1997. The rates of reexploration and patient characteris tics were examined between two time intervals: period I (January 1, 1992 to Tune 1, 1994) and period II (June 1, 1995 to March 31, 1997). All of the r egion's 23 practicing surgeons responsible for these patients were surveyed to assess changes in practice patterns potentially related to bleeding ris ks. Results. The adjusted rates of reexploration for bleeding declined 46% betw een periods I and II (3.6% versus 2.0%, p < 0.001). All of the five cardiac centers in northern New England showed similar trends with adjusted risk r eductions ranging from 32% to 48% between the two time periods. This declin e occurred despite the patients in period II having higher percentages of r isk factors for reexploration for bleeding compared to patients in period I . From the surgeon survey, the number of surgeons using antifibrinolytics m arkedly increased from period I to period II. More surgeons were also using preoperative aspirin and heparin up until the time of surgery in period II . Conclusions. Similar to the rates of mortality, the rates of reexploration for bleeding following CABG surgery are substantially declining. This decre ase in the reexploration rates occurred despite higher patient risks. (C) 1 999 by The Society of Thoracic Surgeons.