DISCUSSION
hemorrhagic complications, bleeding, intraoperative bleeding, Tachyarrhythmias, AKI, alStressing, deaths, respiratory
syndrome coronavirus 2 infection, acute kidney injury
BLEEDING, PNEUMOTHORAX, POSTOPERATIVE BLEEDING, PULMONARY COMPLICATIONS, INTRAOPERATIVE BLEEDING, SURGICAL COMPLICATIONS, CHRONIC ANEMIA, COMPLICATIONS
There are several studies proposing surgical checklists, considering the benefits of
this systematic methodology in reducing complications. However, few studies are
focused on cardiac surgery, especially addressing the review of hemostasis
processes. Considering this, in our study we chose to use a checklist aimed at this
surgical time as proposed by the Royal Papworth Hospital. As in the British study, a
reduction in mediastinal bleeding and reoperation for bleeding rates after use of
the checklist was observed in the sample of our study, although the transfusion rate
did not show a decreaseBy standardizing the steps of the final review of hemostasis, an individual failure
of any item that goes unnoticed is prevented, which reduced the bleeding volume
observed in this sample. However, a lower transfusion rate would be expected in the
checklist group, something that was not observed in our study.Comparing the two groups, the blood products transfusion rate practically remained
the same, which may have occurred not only due to the patients’ preoperative state,
with a high prevalence of chronic anemia, but also due to absence of a specific
protocol such as the one discussed in the study by Bilecen et alAnother advantage of the checklist use was the reduction of some complications
directly related to a lower postoperative bleeding rate, of which the most
significant is acute kidney injury (AKI), the second most common in our study, as
shown in Tachyarrhythmias were frequent complications in our study and followed the same trend
found in the literature. Conti et al.Although not directly related to bleeding rates, a lower incidence of pneumothorax
was observed in G2 patients. The application of the checklist during chest wall
closure implies a more detailed review of hemostasis and, during this review, a
pneumothorax caused by pleural manipulation during the intraoperative period may
have been diagnosed and treated early, avoiding the need for future pleural drainage
in the intensive care environment, which would lead to longer hospital stay (which
occurred with G1 patients).Some studies showed results similar to ours regarding the reoperation for bleeding
rate. Loor et al.Most studies carried out in the last two years have been affected by the COVID-19
pandemic. Surgeries performed during the activity of severe acute respiratory
syndrome coronavirus 2 infection resulted in a worsening of surgical complications,
especially pulmonary complications, and it was also likely to be associated with
hemorrhagic complications. Wang et al.In our study, the use of the checklist was accompanied by a statistically significant
reduction in deaths. The inclusion of other aspects to be checked regarding the
perioperative performance of patients can enhance this result, as described by
Spanjersberg et alStressing the importance of intraoperative bleeding control, in their study, Mazzeffi
et al.