Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study establishing diagnostic criteria and prognostic importance

被引：34

作者：

Roshanov, Pavel S. ^{[1
]}

Eikelboom, John W. ^{[2
,3
]}

Sessler, Daniel, I ^{[4
]}

Kearon, Clive ^{[2
,5
]}

Guyatt, Gordon H. ^{[2
,6
]}

Crowther, Mark ^{[2
]}

Tandon, Vikas ^{[2
]}

Borges, Flavia Kessler ^{[2
,3
]}

Lamy, Andre ^{[6
,7
]}

Whitlock, Richard ^{[3
,6
,7
]}

Biccard, Bruce M. ^{[8
,9
]}

Szczeklik, Wojciech ^{[10
]}

Panju, Mohamed ^{[2
]}

Spence, Jessica ^{[3
]}

Garg, Amit X. ^{[1
,11
]}

McGillion, Michael ^{[3
,12
]}

VanHelder, Tomas ^{[13
]}

Kavsak, Peter A. ^{[14
]}

de Beer, Justin ^{[7
]}

Winemaker, Mitchell ^{[7
]}

Le Manach, Yannick ^{[3
,6
,13
]}

Sheth, Tej ^{[2
]}

Pinthus, Jehonathan H. ^{[7
]}

Siegal, Deborah ^{[2
]}

Thabane, Lehana ^{[3
,6
,15
]}

Simunovic, Marko R., I ^{[6
,7
]}

Mizera, Ryszard ^{[2
]}

Ribas, Sebastian ^{[2
]}

Devereaux, Philip J. ^{[2
,3
,6
]}

机构：

[1] London Hlth Sci Ctr, Div Nephrol, London, ON, Canada

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] Populat Hlth Res Inst, Hamilton, ON, Canada

[4] Cleveland Clin, Anesthesiol Inst, Dept Outcomes Res, Cleveland, OH 44106 USA

[5] Thrombosis & Atherosclerosis Res Inst, Hamilton, ON, Canada

[6] Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[7] McMaster Univ, Dept Surg, Hamilton, ON, Canada

[8] Groote Schuur Hosp, Dept Anaesthesia & Perioperat Med, Cape Town, Western Cape, South Africa

[9] Univ Cape Town, Cape Town, Western Cape, South Africa

[10] Jagiellonian Univ, Dept Intens Care & Perioperat Med, Med Coll, Krakow, Poland

[11] Inst Clin Evaluat Sci Western, London, ON, Canada

[12] Fac Hlth Sci, Sch Nursing, Kingston, ON, Canada

[13] Dept Anesthesia, Ottawa, ON, Canada

[14] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

[15] St Josephs Healthcare, Biostat Unit, Hamilton, ON, Canada

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2021年 / 126卷 / 01期

基金：

英国医学研究理事会; 加拿大健康研究院;

关键词：

anaemia; mortality; noncardiac surgery; perioperative bleeding; postoperative outcome; transfusion;

D O I：

10.1016/j.bja.2020.06.051

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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.

引用

页码：163 / 171

页数：9

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