Excessive bleeding predictors after cardiac surgery in adults: integrative review

Abstract

Aims and objectives: To integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults.

Background: Perioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable.

Design: Integrative literature review.

Methods: Articles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open-heart surgery from 2004-2014 were included.

Results: Predictors of excessive bleeding after cardiac surgery were: Patient-related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure-related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross-clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass-induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis.

Conclusions: Patient-related, procedure-related and postoperative predictors of excessive bleeding after cardiac surgery were identified.

Relevance to clinical practice: The predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.

Keywords: bleeding; cardiac surgery; cardiac surgical procedures; haemorrhage; nursing; postoperative haemorrhage; risk factors; thoracic surgery.