Predictors of blood transfusion requirement in elective liver resection. HPB (Oxford) 2010 Feb;12(1):50-5
Date
05/25/2010Pubmed ID
20495645Pubmed Central ID
PMC2814404DOI
10.1111/j.1477-2574.2009.00126.xScopus ID
2-s2.0-75449092019 (requires institutional sign-in at Scopus site) 36 CitationsAbstract
BACKGROUND: Liver resection remains major surgery frequently requiring intra-operative blood transfusion. Patients are typically over cross-matched, and with blood donor numbers falling, cross-matching and transfusion policies need rationalizing.
AIM: To identify predictors of peri-operative blood transfusion.
METHODS: A retrospective review of elective hepatic resections over a 4-year period was performed. Twenty-six variables including clinicopathological variables and intra-operative data were collated, together with the number of units of blood cross-matched and transfused in the immediate peri-operative period (48 h). Multivariate regression analysis was performed to identify independent predictors of blood transfusion, and a Risk Score for transfusion constructed.
RESULTS: Five hundred and eighty-nine patients were included in the study, and were cross-matched with a median 10 units of blood. Seventeen per cent of patients received a blood transfusion; median transfusion when required was 2 units. Regression analysis identified seven factors predictive of transfusion: haemoglobin <12.5 g/dL, pre-operative biliary drainage, coronary artery disease, largest tumour >3.5 cm, cholangiocarcinoma, redo resection and extended resection (5+ segments). Patients were stratified into high or low risk of transfusion based on Risk Score with a sensitivity of 73% [receiver-operating characteristic (ROC) 0.77].
CONCLUSIONS: Patients undergoing elective liver resection are over-cross-matched. Patients can be classified into high and low risk of transfusion using a Risk Score, and cross-matched accordingly.
Author List
Cockbain AJ, Masudi T, Lodge JP, Toogood GJ, Prasad KRAuthor
Kondragunta Rajendra Prasad MBBS Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Blood Grouping and Crossmatching
Blood Loss, Surgical
Blood Transfusion
Chi-Square Distribution
Elective Surgical Procedures
Female
Hepatectomy
Humans
Logistic Models
Male
Middle Aged
Perioperative Care
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Young Adult
