The impact of pre- and post-bypass activated clotting time on postoperative recovery in cardiopulmonary bypass patients at Peshawar Institute of Cardiology, Peshawar Pakistan patients at Peshawar Institute of Cardiology, Peshawar Pakistan

Introduction: Cardiopulmonary bypass (CPB) is essential in cardiac surgery, but it can lead to complications such as bleeding and prolonged recovery. Activated clotting time (ACT) is crucial for anticoagulation management during CPB. Elevated post-bypass ACT values have been associated with increased postoperative complications, including bleeding, transfusion needs, and prolonged recovery. Objective: To determine the impact of pre- and post-bypass ACT on postoperative recovery, specifically focusing on ICU stay, mechanical ventilation, transfusions, and bleeding events. Methodology: This retrospective cohort study was conducted at the Peshawar Institute of Cardiology, Peshawar Pakistan from June 2023 to July 2024, including 250 patients aged 18 years and older undergoing elective cardiac surgery with CPB. Data were collected from patient records, analyzing pre- and post-bypass ACT, CPB duration, and postoperative recovery parameters. Statistical analysis was conducted using SPSS version 25 with p< 0.05 considered statistically significant. Results: A total of 250 patients were included, with a median age of 56 years. Among CPB patients, 77(30.8%) had a post-bypass ACT≥140 seconds. A significant association was observed between post-bypass ACT≥140 seconds and several adverse postoperative outcomes like, longer mechanical ventilation (p<0.0001), prolonged ICU stays (p<0.0001), increased transfusion rates (p=0.039) and major bleeding events (p<0.0001). The logistic regression model showed post-bypass ACT as a significant predictor for prolonged ICU (OR=1.099, p<0.001) and ventilation stays (OR=1.018, p=0.003). Conclusion: Elevated post-bypass ACT was associated with prolonged ICU and mechanical ventilation stays, increased transfusion requirements, and major bleeding events. Given the retrospective single-center design, these findings should be considered hypothesis-generating and require prospective multicentre validation.