Retained blood complications

Retained blood complications (RBC) result from the ineffective evacuation of blood and fluid from a surgical or traumatic wound after surgery. This can happen after nearly any operation or major trauma, but especially operations like heart surgery, thoracic surgery, trauma surgery, general surgery, orthopedic surgery, neurosurgery, pelvic surgery or plastic surgery. In nearly all of these specialties, surgical drains are needed to removed blood and fluid from the surgical wounds in the early phase of recovery. RBC can develop when these drains fail to perform the required task which is to drain blood, fluid, and air from the surgical wound.

Although RBC can occur after any procedure that requires a drainage catheter, RBC is probably best recognized after cardiac surgery, where chest tubes are used to drain blood from around the heart and lungs in the early hours after surgery. If the evacuation of blood is incomplete, RBC can occur. Clinically, RBC can be recognized acutely or subacutely. When it presents acutely, it is usually fresh thrombus around the heart or lungs presenting as tamponade or hemothorax. When it presents subacutely, it results in bloody pleural or pericardial effusions. Once RBC occurs, subsequent procedures May Be needed to remedy it. In an analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) data from 2010, RBC could be demonstrated in 17% of patients. In this analysis, mortality was doubled from 3% to 6%, length of stay was increased by 5 days, and average costs were 55% higher. Patients with RBC, therefore, appear to be at increased at risk for complications and costs.

Recently it has become better understood that the postoperative obstruction of conventional chest tubes with blood and other fibrinous material in the setting of postoperative bleeding is central to the root cause of RBC. When blood encounters the surfaces of chest tubes, the coagulation cascade is initiated, which often lead to partial or complete chest tube clogging with clot. In a recent study of postoperative cardiac surgery patients at the Cleveland Clinic, 36% of patients were found to have evidence of chest tube obstruction. If chest tube obstruction occurs when a patient is still bleeding after heart surgery, RBC ensues.