Morbidity of Bleeding After Cardiac Surgery: Is It Blood Transfusion, Reoperation for Bleeding, or Both? Alessandro Vivacqua, MD, Colleen G. Koch, MD,

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Morbidity of Bleeding After Cardiac Surgery: Is It Blood Transfusion, Reoperation for Bleeding, or Both? Alessandro Vivacqua, MD, Colleen G. Koch, MD, MBA, Arshad M. Yousuf, MD, Edward R. Nowicki, MD, MS, Penny L. Houghtaling, MS, Eugene H. Blackstone, MD, Joseph F. Sabik, MD The Annals of Thoracic Surgery Volume 91, Issue 6, Pages 1780-1790 (June 2011) DOI: 10.1016/j.athoracsur.2011.03.105 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Mirrored histogram of propensity matched scores for reoperation for bleeding versus no reoperation for bleeding. Reoperation is displayed beneath the baseline in dark green and no reoperation above the baseline in light green. Inset: Scale reduced to depict details. The Annals of Thoracic Surgery 2011 91, 1780-1790DOI: (10.1016/j.athoracsur.2011.03.105) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Standardized differences before and after matching for patients who underwent reoperation for bleeding versus those who did not. (AV any = aortic valve repair or replacement; AVR = aortic valve replacement; BMI = body mass index; BUN = blood urea nitrogen; CABG = coronary artery bypass grafting; COPD = chronic obstructive pulmonary disease; FFP = fresh frozen plasma; LVEF = left ventricular ejection fraction; LCx = left circumflex coronary artery; MVR = mitral valve replacement; NYHA = New York Heart Association; PAD = peripheral arterial disease; RBC = red blood cells; reop = reoperation.) The Annals of Thoracic Surgery 2011 91, 1780-1790DOI: (10.1016/j.athoracsur.2011.03.105) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Predicted probability of operative mortality from multivariable model (Table 5) stratified on reoperation for bleeding and depicted for number of red blood cell (RBC) units transfused. The nomogram was solved for a 65-year-old patient with no chronic obstructive pulmonary disease or heart block, ejection fraction of 0.50, height of 170 cm, creatinine level of 1.4 mg/dL−1, and bilirubin level of 0.6 mg/dL−1 undergoing a 1-component elective operation with a cardiopulmonary bypass time of 95 minutes and myocardial ischemic time of 65 minutes. The Annals of Thoracic Surgery 2011 91, 1780-1790DOI: (10.1016/j.athoracsur.2011.03.105) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Predicted probability of major morbidity from multivariable model (Table 6) stratified on reoperation for bleeding and depicted for number of red blood cell (RBC) units transfused. The nomogram was solved for the same patient characteristics as in Figure 3. The Annals of Thoracic Surgery 2011 91, 1780-1790DOI: (10.1016/j.athoracsur.2011.03.105) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions