Preoperative prediction of Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study. (January 2021)

• Record Type: Journal Article
• Authors: Roshanov, Pavel S.; Guyatt, Gordon H.; Tandon, Vikas; Borges, Flavia K.; Lamy, Andre; Whitlock, Richard; Biccard, Bruce M.; Szczeklik, Wojciech; Panju, Mohamed; Spence, Jessica; Garg, Amit X.; McGillion, Michael; Eikelboom, John W.; Sessler, Daniel I.; Kearon, Clive; Crowther, Mark; VanHelder, Tomas; Kavsak, Peter A.; de Beer, Justin; Winemaker, Mitchell; Le Manach, Yannick; Sheth, Tej; Pinthus, Jehonathan H.; Siegal, Deborah; Thabane, Lehana; Simunovic, Marko R.I.; Mizera, Ryszard; Ribas, Sebastian; Devereaux, Philip J.
• Is Part Of: British journal of anaesthesia. Volume 126:Number 1(2021)
• Page Start: 172
• Page End: 180
• Publication Date: 2021-01
• Subjects: mortality -- noncardiac surgery -- perioperative bleeding -- prediction -- risk index -- transfusion; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2020.02.028
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Diagnostic criteria for Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) have been defined as bleeding that leads to a postoperative haemoglobin <70 g L −1, leads to blood transfusion, or is judged to be the direct cause of death. Preoperative prediction guides for BIMS can facilitate informed consent and planning of perioperative care. Methods: In a prospective cohort study of 16 079 participants aged ≥45 yr having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011, 17.3% (2782) experienced BIMS. An electronic risk calculator for BIMS was developed and internally validated by logistic regression with bootstrapping, and further simplified to a risk index. Decision curve analysis assessed the potential utility of each prediction guide compared with a strategy of identifying risk of BIMS based on preoperative haemoglobin <120 g L −1 . Results: With information about the type of surgery, preoperative haemoglobin, age, sex, functional status, kidney function, history of high-risk coronary artery disease, and active cancer, the risk calculator accurately predicted BIMS (bias-corrected C-statistic, 0.84; 95% confidence interval, 0.837–0.852). A simplified index based on preoperative haemoglobin <120 g L −1, open surgery, and high-risk surgery also predicted BIMS, but less accurately (C-statistic, 0.787; 95% confidence interval, 0.779–0.796). Both prediction guides could improve decision making compared with knowledge of haemoglobin <120 g L −1 alone. Conclusions: BIMS, defined as bleeding that leads to a postoperative haemoglobin <70 g L −1, leads to blood transfusion, or that is judged to be the direct cause of death, can be predicted by a simple risk index before surgery. Clinical trial registration: NCT00512109.