Evaluating the utility of the HAS-BLED bleeding-estimator tool for transurethral resection of prostate

Objectives

To evaluate the utility of the HAS-BLED bleeding risk-estimation tool to predict for clinically significant postoperative haematuria in patients receiving transurethral resection of prostate (TURP).

Patients and Methods

A single-centre, retrospective cohort analysis of patients underwent TURP from April 2019 to December 2023 for treatment of symptomatic benign prostate hyperplasia. The primary objective was to evaluate reliability of HAS-BLED score in predicting postoperative bleeding event. A focus sub-analysis was performed on anticoagulated patient cohort. Each patient was categorised in to HASBLED low-, moderate- and high-risk group according to the preestablished estimator tool. Patients' demographics, clinical, pathological and operative details were collected. Events of clinically significant haematuria within 3 months postoperatively were captured. Cohort characteristics and outcome were analysed with two-sided t test and ANOVA test. Further weight-adjusted multivariable analysis and ROC curve was performed to evaluate the predictive value of HAS-BLED score.

Results

Our analysis showed that patients assigned as high-risk by HAS-BLED were at 2.17-times higher chance of developing clinically significant haematuria compared to the low-risk patients. The risk for high-risk patient was 18.5% (95%CI 11.7–25.3%) and 8.5% (95%CI 4.6–12.4%) for low-risk patients. Moderate-risk did not demonstrate any significant difference relative to the low-risk group. Sub-analysis of 113 patients receiving long-term anticoagulation accentuates the utility of the tool. The risk of haematuria for high-risk patient was 32.7% (95%CI 20.7–44.7%), moderate-risk patient was 28.7% (95%CI 17.0–40.3%), and low-risk patient was 9.7% (95%CI 4.2–15.2%). In this cohort, the risk of haematuria was 3.37 and 2.96 times higher in the high and moderate-risk compared to the low-risk group, respectively.

Conclusion

This is the first study to validate a bleeding estimator tool for TURP patients. High HAS-BLED score positively predicts clinically significant post-TURP haematuria, particularly for patients receiving anticoagulation therapy.