TY - JOUR
T1 - Cardiac Surgical Bleeding, Transfusion, and Quality Metrics
T2 - Joint Consensus Statement by the Enhanced Recovery After Surgery Cardiac Society and Society for the Advancement of Patient Blood Management
AU - Salenger, Rawn
AU - Arora, Rakesh C.
AU - Bracey, Arthur
AU - D'Oria, Mario
AU - Engelman, Daniel T.
AU - Evans, Caroline
AU - Grant, Michael C.
AU - Gunaydin, Serdar
AU - Morton, Vicki
AU - Ozawa, Sherri
AU - Patel, Prakash A.
AU - Raphael, Jacob
AU - Rosengart, Todd K.
AU - Shore-Lesserson, Linda
AU - Tibi, Pierre
AU - Shander, Aryeh
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2024
Y1 - 2024
N2 - Background: Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality, and cost. Methods: An international expert panel was convened to develop consensus statements on the control of bleeding and management of transfusion and to suggest key quality metrics for cardiac surgical bleeding. The panel reviewed relevant literature from the previous 10 years and used a modified RAND Delphi methodology to achieve consensus. Results: The panel developed 30 consensus statements in 8 categories, including prioritizing control of bleeding, prechest closure checklists, and the need for additional quality indicators beyond reexploration rate, such as time to reexploration. Consensus was also reached on the need for a universal definition of excessive bleeding, the use of antifibrinolytics, optimal cessation of antithrombotic agents, and preoperative risk scoring based on patient and procedural factors to identify those at greatest risk of excessive bleeding. Furthermore, an objective bleeding scale is needed based on the volume and rapidity of blood loss accompanied by viscoelastic management algorithms and standardized, patient-centered blood management strategies reflecting an interdisciplinary approach to quality improvement. Conclusions: Prioritizing the timely control and management of bleeding is essential to improving patient outcomes in cardiac surgery. To this end, a cardiac surgical bleeding quality metric that is more comprehensive than reexploration rate alone is needed. Similarly, interdisciplinary quality initiatives that seek to implement enhanced quality indicators will likely lead to improved patient care and outcomes.
AB - Background: Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality, and cost. Methods: An international expert panel was convened to develop consensus statements on the control of bleeding and management of transfusion and to suggest key quality metrics for cardiac surgical bleeding. The panel reviewed relevant literature from the previous 10 years and used a modified RAND Delphi methodology to achieve consensus. Results: The panel developed 30 consensus statements in 8 categories, including prioritizing control of bleeding, prechest closure checklists, and the need for additional quality indicators beyond reexploration rate, such as time to reexploration. Consensus was also reached on the need for a universal definition of excessive bleeding, the use of antifibrinolytics, optimal cessation of antithrombotic agents, and preoperative risk scoring based on patient and procedural factors to identify those at greatest risk of excessive bleeding. Furthermore, an objective bleeding scale is needed based on the volume and rapidity of blood loss accompanied by viscoelastic management algorithms and standardized, patient-centered blood management strategies reflecting an interdisciplinary approach to quality improvement. Conclusions: Prioritizing the timely control and management of bleeding is essential to improving patient outcomes in cardiac surgery. To this end, a cardiac surgical bleeding quality metric that is more comprehensive than reexploration rate alone is needed. Similarly, interdisciplinary quality initiatives that seek to implement enhanced quality indicators will likely lead to improved patient care and outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85207154103&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2024.06.039
DO - 10.1016/j.athoracsur.2024.06.039
M3 - Article
C2 - 39222899
AN - SCOPUS:85207154103
SN - 0003-4975
VL - 119
SP - 280
EP - 295
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -