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Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance.
Roshanov, Pavel S; Eikelboom, John W; Sessler, Daniel I; Kearon, Clive; Guyatt, Gordon H; Crowther, Mark; Tandon, Vikas; Borges, Flavia Kessler; Lamy, Andre; Whitlock, Richard; Biccard, Bruce M; Szczeklik, Wojciech; Panju, Mohamed; Spence, Jessica; Garg, Amit X; McGillion, Michael; 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.
Afiliación
  • Roshanov PS; Division of Nephrology, London Health Science Centre, London, ON, Canada. Electronic address: pavel.roshanov@lhsc.on.ca.
  • Eikelboom JW; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
  • Sessler DI; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Kearon C; Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Canada.
  • Guyatt GH; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada.
  • Crowther M; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Tandon V; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Borges FK; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
  • Lamy A; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Whitlock R; Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Biccard BM; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Observatory, Cape Town, Western Cape, South Africa; University of Cape Town, Rondebosch, Cape Town, Western Cape, South Africa.
  • Szczeklik W; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  • Panju M; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Spence J; Population Health Research Institute, Hamilton, ON, Canada.
  • Garg AX; Division of Nephrology, London Health Science Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences at Western, London, ON, Canada.
  • McGillion M; Population Health Research Institute, Hamilton, ON, Canada; School of Nursing, Faculty of Health Sciences, Canada.
  • VanHelder T; Department of Anesthesia, Canada.
  • Kavsak PA; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
  • de Beer J; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Winemaker M; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Le Manach Y; Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Anesthesia, Canada.
  • Sheth T; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Pinthus JH; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Siegal D; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Thabane L; Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada.
  • Simunovic MRI; Department of Health Research Methods, Evidence, and Impact, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • Mizera R; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Ribas S; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Devereaux PJ; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Canada.
Br J Anaesth ; 126(1): 163-171, 2021 01.
Article en En | MEDLINE | ID: mdl-32768179
BACKGROUND: We aimed to establish diagnostic criteria for bleeding independently associated with mortality after noncardiac surgery (BIMS) defined as bleeding during or within 30 days after noncardiac surgery that is independently associated with mortality within 30 days of surgery, and to estimate the proportion of 30-day postoperative mortality potentially attributable to BIMS. METHODS: This was a prospective cohort study of participants ≥45 yr old having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011. Cox proportional hazards models evaluated the adjusted relationship between candidate diagnostic criteria for BIMS and all-cause mortality within 30 days of surgery. RESULTS: Of 16 079 participants, 2.0% (315) died and 36.1% (5810) met predefined screening criteria for bleeding. Based on independent association with 30-day mortality, BIMS was identified as bleeding leading to a postoperative haemoglobin <70 g L-1, transfusion of ≥1 unit of red blood cells, or that was judged to be the cause of death. Bleeding independently associated with mortality after noncardiac surgery occurred in 17.3% of patients (2782). Death occurred in 5.8% of patients with BIMS (161/2782), 1.3% (39/3028) who met bleeding screening criteria but not BIMS criteria, and 1.1% (115/10 269) without bleeding. BIMS was associated with mortality (adjusted hazard ratio: 1.87; 95% confidence interval: 1.42-2.47). We estimated the proportion of 30-day postoperative deaths potentially attributable to BIMS to be 20.1-31.9%. CONCLUSIONS: Bleeding independently associated with mortality after noncardiac surgery (BIMS), defined as bleeding that leads to a postoperative haemoglobin <70 g L-1, blood transfusion, or that is judged to be the cause of death, is common and may account for a quarter of deaths after noncardiac surgery. CLINICAL TRIAL REGISTRATION: NCT00512109.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Hemorragia Posoperatoria Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Año: 2021 Tipo del documento: Article
Texto completo
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Hemorragia Posoperatoria Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Año: 2021 Tipo del documento: Article