TY - JOUR T1 - Bleeding impacting mortality after noncardiac surgery: a protocol to establish diagnostic criteria, estimate prognostic importance, and develop and validate a prediction guide in an international prospective cohort study JF - CMAJ Open SP - E594 LP - E603 DO - 10.9778/cmajo.20160106 VL - 5 IS - 3 AU - Pavel S. Roshanov AU - John W. Eikelboom AU - Mark Crowther AU - Vikas Tandon AU - Flavia K. Borges AU - Clive Kearon AU - Andre Lamy AU - Richard Whitlock AU - Bruce M. Biccard AU - Wojciech Szczeklik AU - Gordon H. Guyatt AU - Mohamed Panju AU - Jessica Spence AU - Amit X. Garg AU - Michael McGillion AU - Tomas VanHelder AU - Peter A. Kavsak AU - Justin de Beer AU - Mitchell Winemaker AU - Daniel I. Sessler AU - Yannick Le Manach AU - Tej Sheth AU - Jehonathan H. Pinthus AU - Lehana Thabane AU - Marko R.I. Simunovic AU - Ryszard Mizera AU - Sebastian Ribas AU - P.J. Devereaux AU - the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) AU - Investigators Y1 - 2017/08/04 UR - http://www.cmajopen.ca/content/5/3/E594.abstract N2 - Introduction: Various definitions of bleeding have been used in perioperative studies without systematic assessment of the diagnostic criteria for their independent association with outcomes important to patients. Our proposed definition of bleeding impacting mortality after noncardiac surgery (BIMS) is bleeding that is independently associated with death during or within 30 days after noncardiac surgery. We describe our analysis plan to sequentially 1) establish the diagnostic criteria for BIMS, 2) estimate the independent contribution of BIMS to 30-day mortality and 3) develop and internally validate a clinical prediction guide to estimate patient-specific risk of BIMS.Methods: In the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) study, we prospectively collected bleeding data for 16 079 patients aged 45 years or more who had noncardiac inpatient surgery between 2007 and 2011 at 12 centres in 8 countries across 5 continents. We will include bleeding features independently associated with 30-day mortality in the diagnostic criteria for BIMS. Candidate features will include the need for reoperation due to bleeding, the number of units of erythrocytes transfused, the lowest postoperative hemoglobin concentration, and the absolute and relative decrements in hemoglobin concentration from the preoperative value. We will then estimate the incidence of BIMS and its independent association with 30-day mortality. Last, we will construct and internally validate a clinical prediction guide for BIMS.Interpretation: This study will address an important gap in our knowledge about perioperative bleeding, with implications for the 200 million patients who undergo noncardiac surgery globally every year. Trial registration: ClinicalTrials.gov, no NCT00512109. ER -