Comment

. 2021 Jan;126(1):172-180.

doi: 10.1016/j.bja.2020.02.028. Epub 2020 Jul 24.

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

Pavel S Roshanov¹, Gordon H Guyatt², Vikas Tandon³, Flavia K Borges⁴, Andre Lamy⁵, Richard Whitlock⁶, Bruce M Biccard⁷, Wojciech Szczeklik⁸, Mohamed Panju³, Jessica Spence⁹, Amit X Garg¹⁰, Michael McGillion¹¹, John W Eikelboom⁴, Daniel I Sessler¹², Clive Kearon¹³, Mark Crowther³, Tomas VanHelder¹⁴, Peter A Kavsak¹⁵, Justin de Beer¹⁶, Mitchell Winemaker¹⁶, Yannick Le Manach¹⁷, Tej Sheth³, Jehonathan H Pinthus¹⁶, Deborah Siegal³, Lehana Thabane¹⁸, Marko R I Simunovic⁵, Ryszard Mizera³, Sebastian Ribas³, Philip J Devereaux¹⁹

Affiliations

¹ Division of Nephrology, London Health Science Centre, London, ON, Canada. Electronic address: pavel.roshanov@lhsc.on.ca.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁷ 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.
⁸ Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
⁹ Population Health Research Institute, Hamilton, ON, Canada.
¹⁰ Division of Nephrology, London Health Science Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences at Western, London, ON, Canada.
¹¹ Population Health Research Institute, Hamilton, ON, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹² Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
¹³ Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
¹⁵ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
¹⁶ Department of Surgery, McMaster University, Hamilton, ON, Canada.
¹⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
¹⁸ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada.
¹⁹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.

PMID: 32718723
DOI: 10.1016/j.bja.2020.02.028

Free article

Comment

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

Pavel S Roshanov et al. Br J Anaesth. 2021 Jan.

Free article

. 2021 Jan;126(1):172-180.

doi: 10.1016/j.bja.2020.02.028. Epub 2020 Jul 24.

Authors

Affiliations

¹ Division of Nephrology, London Health Science Centre, London, ON, Canada. Electronic address: pavel.roshanov@lhsc.on.ca.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁷ 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.
⁸ Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
⁹ Population Health Research Institute, Hamilton, ON, Canada.
¹⁰ Division of Nephrology, London Health Science Centre, London, ON, Canada; Institute for Clinical Evaluative Sciences at Western, London, ON, Canada.
¹¹ Population Health Research Institute, Hamilton, ON, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹² Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
¹³ Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
¹⁵ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
¹⁶ Department of Surgery, McMaster University, Hamilton, ON, Canada.
¹⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
¹⁸ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada.
¹⁹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.

PMID: 32718723
DOI: 10.1016/j.bja.2020.02.028

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.

Keywords: mortality; noncardiac surgery; perioperative bleeding; prediction; risk index; transfusion.

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Comment in

Bleeding, anaemia, and transfusion: an ounce of prevention is worth a pound of cure.
Frank SM, Cushing MM. Frank SM, et al. Br J Anaesth. 2021 Jan;126(1):5-9. doi: 10.1016/j.bja.2020.09.009. Epub 2020 Sep 25. Br J Anaesth. 2021. PMID: 32981674 No abstract available.

Comment on

Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance.
Roshanov PS, Eikelboom JW, Sessler DI, Kearon C, Guyatt GH, Crowther M, Tandon V, Borges FK, Lamy A, Whitlock R, Biccard BM, Szczeklik W, Panju M, Spence J, Garg AX, McGillion M, VanHelder T, Kavsak PA, de Beer J, Winemaker M, Le Manach Y, Sheth T, Pinthus JH, Siegal D, Thabane L, Simunovic MRI, Mizera R, Ribas S, Devereaux PJ. Roshanov PS, et al. Br J Anaesth. 2021 Jan;126(1):163-171. doi: 10.1016/j.bja.2020.06.051. Epub 2020 Aug 5. Br J Anaesth. 2021. PMID: 32768179

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

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

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