title: Universal definition of perioperative bleeding in adult cardiac surgery.
abstract: OBJECTIVE
  Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and quantify bleeding and to facilitate future investigation into this difficult clinical problem.
  
  
  METHODS
  The multidisciplinary International Initiative on Haemostasis Management in Cardiac Surgery identified a common definition of perioperative bleeding as an unmet need. The functionality and usefulness of the UDPB for clinical research was then tested using a large single-center, nonselected, cardiac surgical database.
  
  
  RESULTS
  A multistaged definition for perioperative bleeding was created based on easily measured clinical end points, including total blood loss from chest tubes within 12 hours, allogeneic blood products transfused, surgical reexploration including cardiac tamponade, delayed sternal closure, and the need for salvage treatment. Depending on these components, bleeding is graded as insignificant, mild, moderate, severe, or massive. When applied to an established cardiac surgery dataset, the UDPB provided insight into the incidence and outcome of bleeding after cardiac surgery.
  
  
  CONCLUSIONS
  The proposed UDPB in adult cardiac surgery provides a precise classification of bleeding that is useful in everyday practice as well as in clinical research. Once fully validated, the UDPB may be useful as an institutional quality measure and serve as an important end point in future cardiac surgical research.
authors: Department of Cardiothoracic Surgery, University of North Dakota School of Medicine and Health Sciences, Sanford Health Fargo, Fargo, ND. Electronic address: cornelius.dyke@sanfordhealth.org.
authors: Cornelius
authors: C
authors: Dyke
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC.
authors: Solomon
authors: S
authors: Aronson
authors: Institute for Research in Cardiac Anesthesia, Munich, Germany.
authors: Wulf
authors: W
authors: Dietrich
authors: Institute of Anaesthesiology, University Hospital, Zurich, Switzerland; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia; Centre for Population Health Research, Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, Western Australia; Medical Society for Blood Management, Laxenburg, Austria.
authors: Axel
authors: A
authors: Hofmann
authors: Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Keyvan
authors: K
authors: Karkouti
authors: Department of Vascular Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marcel
authors: M
authors: Levi
authors: Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, United Kingdom.
authors: Gavin J
authors: GJ
authors: Murphy
authors: Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
authors: Frank W
authors: FW
authors: Sellke
authors: Department of Anesthesiology, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra University School of Medicine, Manhasset, NY.
authors: Linda
authors: L
authors: Shore-Lesserson
authors: Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Christian
authors: C
authors: von Heymann
authors: Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
authors: Marco
authors: M
authors: Ranucci
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002305:Cardiac Tamponade / Q000145:classification; D006489:Hemostatic Techniques; D006801:Humans; D019106:Postoperative Hemorrhage / Q000145:classification* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D012720:Severity of Illness Index; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome