Portal de Periódicos da CAPES

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

2024; American Medical Association; Volume: 7; Issue: 4 Linguagem: Inglês

10.1001/jamanetworkopen.2024.4581

2574-3805

Alex L.E. Halme, Pavel S Roshanov, Sara Tornberg, Lauri I. Lavikainen, P.J. Devereaux, Kari A.O. Tikkinen, Justin DeBeer, Clive Kearon, Richard Mizera, Jehonathan H. Pinthus, Sebastián Ribas, Tej Sheth, Marko Šimunović, Vikas Tandon, Tomas VanHelder, Mitchell Winemaker, James Paul, Zubin Punthakee, Karen Raymer, Anthony Adili, Catherine M. Clase, Deborah J. Cook, James Douketis, Azim S. Gangji, Paul Jackson, Wendy Lim, Peter Lovrics, S Mazzadi, Maria Tiboni, John W. Eikelboom, Javier Gáname, James Hankinson, Stephen Hill, Sanjit S. Jolly, Elizabeth Ling, Patrick Magloire, Guillaume Paré, David Szalay, Jacques G. Tittley, Omid Salehian, Hertzel C. Gerstein, Sadeesh Srinathan, Clare D. Ramsey, Philip St. John, Laurel Thorlacius, Faisal Sharaf Siddiqui, Hilary P. Grocott, Andrew McKay, T Lee, Ryan Amadeo, Duane J. Funk, Heather McDonald, James Zacharias, Rey Acedillo, Amit X. Garg, Ainslie Hildebrand, Ngan N. Lam, Danielle MacNeil, Marko Mrkobrada, Pavel S Roshanov, Daniel I. Sessler, Andrea Kurz, Emre Görgün, Amanda J. Naylor, Matt Hutcherson, Zhuo Sun, Bianka Nguyen, Michael Di Palma, Avis Cuko, Aram Shahinyan, Vinayak Nadar, Mauricio Perilla, Kamal Maheshwari, Alparslan Turan, Rupert M. Pearse, Edyta Niebrzegowska, Andrew Wrag, Andrew Archbold, Elisa Kam, Kirsty Everingham, Phoebe Bodger, Thais Creary, Ben Bloom, Alice S. Carter, Tom Abbott, Nirav Shah, Katarzyna Mrozek, Amy Richardson, Alexander J. Fowler, Zakaria Rob, Gareth L. Ackland, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Ana Gutierrez del Arroyo, Shamir Karmali, Colin C. Williams, A. Rushton, Ingeborg Welters, M. Leuwer, Jane Parker, Robert J. Sapsford, Julian H. Barth, Julian Scott, Alistair S. Hall, Simon Howell, Michaela Lobley, Janet Woods, Susannah Howard, Joanne Fletcher, Nikki Dewhirst, Wojciech Szczeklik, Jacek Górka, Karolina Górka, Bogusz Kaczmarek, Kamil Polok, Jolanta Gąsior, Anna Włudarczyk, Magdalena Duchińska, Jakub Fronczek, Aleksandra Wojnarska, Mateusz Kózka, Andrzej Hałek, Pierre Coriat, Denis Monneret, Marie-Hélène Fléron, Jean Pierre Goarin, Cristina Ibáñez, Catherine A. Royer, G Daas, Valsa Abraham, Preetha George, Denis Xavier, Alben Sigamani, Atiya Faruqui, Radhika Dhanpal, Smitha Almeida, J Cherian, Sultana Furruqh, Wang Cy, G. S. Y. Ong, Marzida Mansor, Alvin Tan, II Shariffuddin, NHM Hashim, Abdul Wahab Undok, HY Lai, Wan Azman Wan Ahmad, PS Loh, CY Chong, AHA Razack, Matthew T.V. Chan, Gordon YS Choi, Lydia CW Lit, Tony Gin, Alex Wan, Linda Lai, P.W.H. Chan, Germán Málaga, Vanessa Valderrama-Victoria, Javier D Loza-Herrera, Maria Lazo, Aida Rotta, Otávio Berwanger, Érica Aranha Suzumura, Eliana Vieira Santucci, Kátia Ramos Moreira Leite, Jose Amalth do Espirirto Santo, Cesar AP Jardim, Alexandre Biasi Cavalcanti, Hélio Penna Guimarães, Carísi Anne Polanczyk, Mariana Vargas Furtado, Olga Cortés, Félix R. Montes, Paula Alvarado, Juan Carlos Villar, Skarlett Vásquez, Bruce Biccard, Hussein Cassimjee, PD Gopalan, Theroshnie Kisten, Aine Mugabi, Prebashini Naidoo, Rubeshan Naidoo, Reitze Rodseth, David Lee Skinner, Alex Torborg, Clara K Chow, Graham S. Hillis, Richard Halliwell, Stephen Li, Vincent Lee, John Mooney,

Hemodynamic Monitoring and Therapy

Importance Although major bleeding is among the most common and prognostically important perioperative complications, the relative timing of bleeding events is not well established. This information is critical for preventing bleeding complications and for informing the timing of pharmacologic thromboprophylaxis. Objective To determine the timing of postoperative bleeding among patients undergoing surgery for up to 30 days after surgery. Design, Setting, and Participants This is a secondary analysis of a prospective cohort study. Patients aged 45 years or older who underwent inpatient noncardiac surgery were recruited in 14 countries between 2007 and 2013, with follow-up until December 2014. Data analysis was performed from June to July 2023. Exposure Noncardiac surgery requiring overnight hospital admission. Main Outcomes and Measures The primary outcome (postoperative major bleeding) was a composite of the timing of the following bleeding outcomes: (1) bleeding leading to transfusion, (2) bleeding leading to a postoperative hemoglobin level less than 7 g/dL, (3) bleeding leading to death, and (4) bleeding associated with reintervention. Each of the components of the composite primary outcome (1-4) and bleeding independently associated with mortality after noncardiac surgery, which was defined as a composite of outcomes 1 to 3, were secondary outcomes. Results Among 39 813 patients (median [IQR] age, 63.0 [54.8-72.5] years; 19 793 women [49.7%]), there were 5340 major bleeding events (primary outcome) in 4638 patients (11.6%) within the first 30 days after surgery. Of these events, 42.7% (95% CI, 40.9%-44.6%) occurred within 24 hours after surgery, 77.7% (95% CI, 75.8%-79.5%) by postoperative day 7, 88.3% (95% CI, 86.5%-90.2%) by postoperative day 14, and 94.6% (95% CI, 92.7%-96.5%) by postoperative day 21. Within 48 hours of surgery, 56.2% of major bleeding events, 56.2% of bleeding leading to transfusion, 56.1% of bleeding independently associated with mortality after noncardiac surgery, 51.8% of bleeding associated with hemoglobin less than 7 g/dL, and 51.8% of bleeding associated with reintervention had occurred. Conclusions and Relevance In this cohort study, of the major postoperative bleeding events in the first 30 days, more than three-quarters occurred during the first postoperative week. These findings are useful for researchers for the planning future clinical research and for clinicians in prevention of bleeding-related surgical complications and in decision-making regarding starting of pharmacologic thromboprophylaxis after surgery.