RESULTS
A total of 117 cardiac surgery patients were reviewed between January 2018 and December 2018 but 39 were excluded because of incomplete TEG data. The final study population was comprised of 78 cardiac surgery patients and was characterized as 58 male (74%) with a mean age of 65±10 years (range, 44-87 years). The mean body-mass-index (BMI) was 29±5 (range 20-43) kg/m2. Patient race was categorized as 65% White (n = 51), 32% Black (n = 25), and 3% Asian (n = 2). The most common medical co-morbidity was hypertension (64%) followed by coronary artery disease (46%) and obesity (35%) There was a near equal distribution of on-pump (48%) and off-pump (51%) cardiac surgery . Median LOS was 12 [8,17] days. Overall mortality was 8%.
Fibrinolytic phenotypes were distributed as 45% physiologic, 32% hypo-, and 23% hyper-. There was no significant difference between age, gender, race, or ethnicity on the distribution of fibrinolysis phenotypes. There was a near equal distribution of fibrinolytic phenotypes between patients who received versus did not receive AF (P = 0.962).
Of the 78 patients included in the analysis, 47% (37/78) received AF and 53% (41/78) did not. When these two groups were further stratified by fibrinolytic phenotypes, the sub-group sizes were too small to make any meaningful determination of whether AF altered outcome .
Table 1 compares demographic and clinical data between groups. There were no statistically significant differences regarding: medical co-morbidities, including hypertension (84% vs 71%, P =0 .172), coronary artery disease (57% vs 37%, P =0 .074), and diabetes (35% vs 34%, P = 0.927), tobacco use (3% vs 12%, P = 0.116), preoperative hematocrit (34 ± 3 vs 33 ± 4, P =0 .430), Caprini score (9 ± 2 vs 9 ± 2, P =0 .201) Clopidogrel use (19% vs 24%, P = 0.559) or Aspirin use (60% vs 78%, P = 0.076).
For AF versus no AF (Table 2), median time with chest tube during post-operative recovery was longer (4 [3,5] vs 3 [2,4] days, p=0.037). Chest tube output was increased (1379 [945,1837] vs 820 [485,1400]), but this apparent difference did not reach statistical significance (P =0 .075). All-cause morbidity was the most significant outcome difference (P = .017), which occurred in 51% of patients who received AF versus 25% of patients who did not receive AF.
Other outcomes were similar, including hospital LOS (13 [8,17] vs 10 [8,17] days, P = .873), EBL (1100 [1000,1500] vs 775 [500,1050] ml, P = .127), transfused RBCs (4 [1,5] vs 2 [1,4] units, P = .152) or all-cause mortality (5.4% vs 10%, P = .518).