METHODS
bleeding, death, mellitus, artéria, infection, postoperative death, blood transfusions, ventricular aneurysm, diabetes
BLEEDING, AORTIC DISSECTION, POSTOPERATIVE INFECTION, INFECTION, DYSLIPIDEMIA, VENTRICULAR ANEURYSM, HYPERTENSION, COMPLICATIONS, DIABETES
A non-randomized clinical trial was developed at the Centro de Cirurgia
Cardiovascular of the Hospital Estadual Mário Covas in a two-year interval. A
non-probabilistic sample was obtained with all patients who underwent cardiac
surgery (coronary artery bypass grafting, valve replacement, aortic dissection
repair, and ventricular aneurysm repair) within the study period, regardless of sex,
age, body mass index (BMI), European System for Cardiac Operative Risk Evaluation
(EuroSCORE) II, ejection fraction, heart rate, comorbidities, or surgery priority
(elective, urgent, or emergency). Patients who underwent heart transplantation or
pulmonary thromboendarterectomy were excluded from the study.Patients were divided into two groups: Group 1 (G1), patients operated without the
use of the checklist, and Group 2 (G2), patients in which the hemostasis checklist
proposed by the Royal Papworth Hospital was used (
Original checklist by the Royal Papworth Hospital. ACT=activated clotting
time; FBC=full blood count; Hb=haemoglobin; LA=left atrium; LIMA=left
internal mammary artery; LV=left ventricular; PA=pulmonary artery;
RA=right atrium; RSPV=right superior pulmonary vein vent; SVG=saphenous
vein graft; TEG=thromboelastogramThe Papworth Haemostasis Checklist was translated into Portuguese and adapted
according to the measurement units (g/dL and mg/dL) used in Brazil and at the
Hospital Estadual Mário Covas (
Translated and adapted checklist used in the study. AD=átrio
direito; AE=átrio esquerdo; AMIE=artéria mamária
interna esquerda; AP=artéria pulmonar; Saf=enxerto de veia
safena; TCA=tempo de coagulação ativado; VE=ventricular
esquerdo; VPSD=ventilação da veia pulmonar superior
direitaThe adapted and translated version of the checklist was applied on a two-week period
in order to access the feasibility of this new process in our service and to build
an awareness culture on the new checklist as a tool to mitigate bleeding
complications in our hospital. After this period, the surgical team had a debriefing
to optimize the application of this checklist in the intraoperative routine. The
major objective of this step was to evaluate how the team would deal with
haemostasis revision using a standardized procedure. It was decided to not analyze
the patients’ data in this step.Preoperative data were collected in a standardized way and included demographic
information (such as weight, height, and BMI), comorbidities (hypertension, diabetes
mellitus, dyslipidemia, and smoking), left ventricular function, and EuroSCORE. In
the postoperative evaluation, the chest tube drainage amount (mL) in the first 24
hours, the need for blood transfusions and reoperation for bleeding, intensive care
unit and hospital length of stay, postoperative infection, and other complications
were observed, as well as postoperative death. Patients were followed up for 30 days
after surgery.All patients were included in the study after written informed consent was obtained.
The project was submitted and approved by the Research Ethics Committee of Centro
Universitário FMABC (CAAE: 7122920.7.0000.0082).A descriptive analysis of the data was performed, and, for qualitative variables, the
absolute and relative frequencies were calculated. As the variables did not follow a
normal distribution by the Shapiro-Wilk test, data were presented as mean and
median.To compare drainage output, amount of blood products, and days of hospitalization
between groups, the Mann-Whitney U test was used. In relation to postoperative
infection, death, and reoperation, Fisher’s exact test was used. A
