title: Preoperative INR and postoperative major bleeding and mortality: A retrospective cohort study.
abstract: Little research has been done on the current cut-off international normalized ratio (INR) value of 1.5 for patients undergoing surgery. The objectives of this study are to assess the association between INR and postoperative major bleeding and mortality in patients undergoing surgery and to identify an ideal pre-operative INR for surgical patients. We analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program database between 2008 and 2011 (636,231 patients). The primary outcomes were major bleeding and mortality at 30 days postoperatively. Multivariate logistic regression analyses were carried out to assess these associations. Compared to an INR of <1, the adjusted odds ratio (aOR) for major bleeding was 1.22 (95 % CI 1.18-1.25) for INR 1-1.49, 1.48 (95 % CI 1.40-1.56) for INR 1.5-1.9, and 1.49 (95 % CI 1.39-1.60) for INR ≥2. The aOR for mortality at 30 days post-operation compared to INR of <1 was 1.51 (95 % CI 1.41-1.62), 2.31 (95 % CI 2.12-2.52), and 2.81 (95 % CI 2.56-3.10) for INR 1-1.49, 1.5-1.9, and ≥2, respectively. The ideal pre-operative INR value to predict an increased risk for major bleeding was 1.10 and 1.13 for mortality. In conclusion, preoperative INR is significantly and independently associated with postoperative major bleeding and mortality.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 11072020, Lebanon. htamim@aub.edu.lb.|Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon. htamim@aub.edu.lb.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC, Canada. mmh89@hotmail.com.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Habbal
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 11072020, Lebanon. ans11@aub.edu.lb.
authors.forename: Antoine
authors.initials: A
authors.lastname: Saliba
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 11072020, Lebanon. kmm06@aub.edu.lb.
authors.forename: Khaled
authors.initials: K
authors.lastname: Musallam
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. maltaki@aub.edu.lb.
authors.forename: Muhyeddine
authors.initials: M
authors.lastname: Al-Taki
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. jh34@aub.edu.lb.
authors.forename: Jamal
authors.initials: J
authors.lastname: Hoballah
authors.affiliation: Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon. sfj01@aub.edu.lb.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jamali
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 11072020, Lebanon. ataher@aub.edu.lb.
authors.forename: Ali
authors.initials: A
authors.lastname: Taher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000401:mortality* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies
keywords: ACS NSQIP; Hemostasis; INR; Outcomes; Prothrombin time; Surgery