Roshanov, P. S., Guyatt, G. H., Tandon, V., Borges, F. K., Lamy, A., Whitlock, R., Biccard, B. M., Szczeklik, W., Panju, M., Spence, J., Garg, A. X., McGillion, M., Eikelboom, J. W., Sessler, D. I., Kearon, C., Crowther, M., VanHelder, T., Kavsak, P. A., de Beer, J., Winemaker, M., Le Manach, Y., Sheth, T., Pinthus, J. H., Siegal, D., Thabane, L., Simunovic, M. R. I., Mizera, R., Ribas, S., Devereaux, P. J. Preoperative prediction of bleeding Independently associated with mortality after noncardiac surgery (BIMS): an international prospective cohort study. Br J Anaesth 2021: 126 (1) 172-180- Outcomes Research Consortium

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Roshanov, P. S., Guyatt, G. H., Tandon, V., Borges, F. K., Lamy, A., Whitlock, R., Biccard, B. M., Szczeklik, W., Panju, M., Spence, J., Garg, A. X., McGillion, M., Eikelboom, J. W., Sessler, D. I., Kearon, C., Crowther, M., VanHelder, T., Kavsak, P. A., de Beer, J., Winemaker, M., Le Manach, Y., Sheth, T., Pinthus, J. H., Siegal, D., Thabane, L., Simunovic, M. R. I., Mizera, R., Ribas, S., Devereaux, P. J. Preoperative prediction of bleeding Independently associated with mortality after noncardiac surgery (BIMS): an international prospective cohort study. Br J Anaesth 2021: 126 (1) 172-180

October 16, 2021

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 L1 , 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 L1. 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, 0.837e0.852). A simplified index based on preoperative haemoglobin <120 g L1 , open surgery, and high-risk surgery also predicted BIMS, but less accurately (C-statistic, 0.787; 95% confidence interval, 0.779e0.796). Both prediction guides could improve decision making compared with knowledge of haemoglobin <120 g L1 alone. Conclusions: BIMS, defined as bleeding that leads to a postoperative haemoglobin <70 g L1 , 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.