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Bleeding Risk after Cardiac Surgery (Papworth BRiSc) Calculator

  • Surgery Priority
  • Surgery Type
  • Aortic Valve Disease (stenosis/regurgitation)
  • BMI (kg/m2)
  • Age (years)
  • Bleeding Risk after Cardiac Surgery (Papworth BRiSc): Explanation and Clinical Context
    This calculator implements the Papworth Bleeding Risk Score (BRiSc), a preoperative stratification tool developed to identify cardiac surgery patients at higher risk of severe early postoperative bleeding. The score uses five routinely available preoperative variables: non-elective surgery status (urgent/emergency), surgery type other than isolated CABG or single-valve surgery, the presence of aortic valve disease, body mass index <25 kg/m2, and age ≥75 years. Each factor contributes one point (0–5 total), classifying risk as Low (0 points), Medium (1–2 points), or High (3–5 points).

    Outcome Definition and Performance
    In the original study at Papworth Hospital (11,592 consecutive cases on cardiopulmonary bypass), “severe postoperative bleeding” was defined as a mean chest drain loss >2 mL/kg/h over the first 3 hours in ICU, or the earliest of transfusion of FFP/platelets/cryoprecipitate, return to theatre, or death. In the validation test set, observed event rates were approximately 3% (low), 8% (medium), and 21% (high), demonstrating clinically meaningful discrimination and calibration for early bleeding risk groups.

    Clinical Significance
    Excessive bleeding and reexploration after cardiac surgery are associated with increased morbidity, longer ICU/hospital stay, and higher short- and long-term mortality. A pragmatic preoperative score like BRiSc can help target blood-sparing strategies (e.g., antifibrinolytics, cell salvage optimization, meticulous hemostasis planning) to higher-risk patients while avoiding unnecessary exposure in lower-risk cases.

    Interpretation Summary
    Use BRiSc to anticipate early postoperative bleeding and to inform perioperative planning. The score is intentionally simple and preoperative; it does not include intraoperative drivers of bleeding (e.g., CPB duration, temperature, complex aortic work), so clinical judgment remains essential. For procedure-specific or center-specific decision-making, consider complementing BRiSc with institutional data, contemporary transfusion protocols, and guideline-based patient blood management pathways.

    References
    Vuylsteke A, Pagel C, Gerrard C, Reddy B, Nashef S, Aldam P, Utley M. The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding. Eur J Cardiothorac Surg. 2011;39(6):924–930. doi:10.1016/j.ejcts.2010.10.003.
    Dyke C, et al. Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg. 2014;147(5):1458–1463. doi:10.1016/j.jtcvs.2013.10.070.
    Goudie R, et al. Risk scores to facilitate preoperative prediction of transfusion and massive transfusion in adult cardiac surgery. Br J Anaesth. 2015;114(5):757–766. doi:10.1093/bja/aeu446.
    De Hert S, et al. Use and safety of aprotinin in routine clinical practice. Eur J Anaesthesiol. 2022;39(8):668–678. (Describes BRiSc variables).
    Petrou A, et al. Massive bleeding in cardiac surgery: definitions, predictors and challenges. Hippokratia. 2016;20(3):179–186.

    Note
    A frequently cited, validated preoperative model for bleeding after cardiac surgery is the Papworth BRiSc. If you were looking for a “Browne index,” there is no widely accepted bleeding score under that name in adult cardiac surgery; Papworth BRiSc aligns with the original peer-reviewed publication and is implemented here for precision and reproducibility.