Validation of the E-CABG Bleeding Severity Classification in Open Peripheral Arterial Surgery

Background: Documentation of perioperative bleeding during vascular procedures is crucial for monitoring efficacy, safety, and to evaluate patient outcomes. This study validated the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding classification for evaluating perioperative bleeding in patients undergoing open peripheral arterial surgery (OPAS). Methods: Prospective, multicenter cohort study including adult patients undergoing elective OPAS. Patients undergoing abdominal aortic surgery were excluded to maintain a homogeneous bleeding risk profile. Primary outcome was the incidence of complications categorized per E-CABG grade. Logistic regression was used to evaluate the predictive ability of Grade I or higher on patient outcomes. The model was adjusted for type of OPAS to minimize heterogeneity. Results: A total of 778 patients were included. Ninety-four patients (12%) suffered a bleeding complication (Grade I: n = 47, 6.0%; Grade II: n = 47, 6.0%). Patients suffering Grade ≥ I had significantly more thrombo-embolic complications (TECs) (P < 0.001), myocardial infarction (P = 0.006), bowel ischemia (P < 0.001), graft thrombosis (P = 0.019), graft infection (P = 0.026), wound infection (P < 0.001), pneumonia (P = 0.024), prolonged duration of hospital admission (P < 0.001), higher reoperation (P < 0.001), and mortality (P < 0.001) than patients without a bleeding complication. In a multivariate model, Grade ≥ I predicted 30-day mortality (area under the curve (AUC) 0.81, 95% confidence interval [CI] 0.63–0.96), reoperation other than bleeding (AUC 0.75, 95% CI 0.66–0.85), wound infection (AUC 0.76, 95% CI 0.72–0.80), and TEC (AUC 0.67, 95% CI 0.58–0.76). Conclusion: The E-CABG bleeding classification is applicable for stratifying the severity of perioperative bleeding in OPAS and predicting adverse short-term postoperative outcomes for research and registry databases.