M. Mavros1,2, A. Ejaz3, Y. Kim2, F. Gani2, T. M. Pawlik2 1MedStar Washington Hospital Center,Surgery,Washington, DC, USA 2Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 3University Of Illinois At Chicago,Surgery,Chicago, IL, USA
Introduction: Blood loss and transfusion have traditionally been a concern when performing a hepatic resection. While many patients will have blood products crossmatched preoperatively, only a proportion will get transfused. We sought to create a score to predict need for transfusion.
Methods: Patients in the 2010-2013 American College of Surgeons National Surgical Quality Improvement Program undergoing liver surgery were analyzed. Multivariable models were constructed to identify independent predictors of perioperative transfusion (≥1 unit PRBCs intraoperatively or within 72 hours postoperatively). A scoring system to estimate odds of transfusion was constructed (n=16,679) and then validated (n=8,169).
Results: Among 24,848 cases analyzed, median age was 60 years and 52% were female. 9001 patients (36%) had a major hepatectomy and 6100 (25%) received a transfusion. Factors predictive of transfusion included preoperative hematocrit (OR 2.4), preoperative transfusion (OR 3.2), major hepatectomy (OR 1.6), extrahepatic surgery (OR 1.3), bleeding disorder (OR 1.8), ASA class (ASA 3-4 OR 1.3, ASA 5 OR 2.1), preoperative albumin, (OR 1.4) and alkaline phosphatase (OR 1.4). A weighted integer score was derived using these factors, which could predict with moderate accuracy the need for transfusion in the validation dataset: score 1 (reference): 9% likelihood of transfusion; score 2: 18%, OR 2.3; score 3: 28%, OR 4.1; score 4: 42%, OR 7.8; score 5: 66%, OR 20.1; AUC: 70.1%.
Conclusion: Up to 1 in 4 patients undergoing hepatic resection required a transfusion. A score derived from preoperative factors including patient comorbidities, laboratory values, and extent of surgery was associated with the need for transfusion.