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

BackgroundDiagnostic 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, blood transfusion, or is judged be the direct cause of death. Preoperative prediction guides BIMS can facilitate informed consent and planning perioperative care.MethodsIn prospective cohort study 16 079 participants aged ≥45 yr having inpatient surgery at 12 academic hospitals in eight countries between 2007 2011, 17.3% (2782) experienced BIMS. An electronic risk calculator was developed internally validated by logistic regression bootstrapping, further simplified index. Decision curve analysis assessed potential utility each guide compared strategy identifying based on preoperative <120 L−1.ResultsWith information about type surgery, haemoglobin, age, sex, functional status, kidney function, history high-risk coronary artery disease, active cancer, accurately predicted (bias-corrected C-statistic, 0.84; 95% confidence interval, 0.837–0.852). A index open also BIMS, but less (C-statistic, 0.787; 0.779–0.796). Both could improve decision making knowledge L−1 alone.ConclusionsBIMS, death, simple before surgery.Clinical trial registrationNCT00512109.