Baylor Scott & White Health, Dallas, Texas; Division of Cardiothoracic Surgery, Washington University in St. Louis, Barnes Jewish Hospital, St Louis, Missouri.
Department of Statistical Sciences, Southern Methodist University, Dallas, Texas; Robbins Institute for Health Policy & Leadership, Baylor University, Waco, Texas.
Ann Thorac Surg. 2024 Oct;118(4):920-930. doi: 10.1016/j.athoracsur.2024.06.022. Epub 2024 Jul 5.
Perioperative blood transfusion is associated with adverse outcomes and higher costs after coronary artery bypass graft (CABG) surgery. We developed risk assessments for patients' probability of perioperative transfusion and the expected transfusion volume to improve clinical management and resource use.
Among 1,266,545 consecutive (2008-2016) isolated CABG operations in The Society of Thoracic Surgeons Adult Cardiac Surgery Database, 657,821 (51.9%) received perioperative transfusions of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate, and/or platelets. We developed "full" models to predict perioperative transfusion of any blood product, and of RBC, FFP, or platelets. Using least absolute shrinkage and selection operator model selection, we built a rapid risk score based on 5 variables (age, body surface area, sex, preoperative hematocrit, and use of intra-aortic balloon pump).
C statistics for the full model were 0.785, 0.815, 0.707, and 0.699 for any blood product, RBC, FFP, and platelets, respectively. C statistics for rapid risk assessments were 0.752, 0.785, 0.670, and 0.661 for any blood product, RBC, FFP, and platelets, respectively. The observed vs expected risk plots showed strong calibration for full models and risk assessment tools; absolute differences between observed and expected risks of transfusion were <10.8% in each percentile of expected risk. Risk assessment-predicted probabilities of transfusion were strongly and nonlinearly associated (P < .0001) with total units transfused.
These robust and well-calibrated risk assessment tools for perioperative transfusion in CABG can inform surgeons regarding patients' risks and the number of RBC, FFP, and platelets units they can expect to need. This can aid in optimizing outcomes and increasing efficient use of blood products.
围手术期输血与冠状动脉旁路移植术（CABG）后不良结局和更高的成本相关。我们开发了患者围手术期输血概率和预期输血量的风险评估，以改善临床管理和资源利用。
在胸外科医师学会成人心脏手术数据库中，连续 1266545 例（2008-2016 年）的单纯 CABG 手术中，657821 例（51.9%）接受了围手术期红细胞（RBC）、新鲜冷冻血浆（FFP）、冷沉淀和/或血小板的输血。我们开发了“全”模型来预测任何血液制品、RBC、FFP 或血小板的围手术期输血。使用最小绝对收缩和选择算子模型选择，我们基于 5 个变量（年龄、体表面积、性别、术前血细胞比容和使用主动脉内球囊泵）构建了一个快速风险评分。
全模型的 C 统计量分别为 0.785、0.815、0.707 和 0.699，用于任何血液制品、RBC、FFP 和血小板。快速风险评估的 C 统计量分别为 0.752、0.785、0.670 和 0.661，用于任何血液制品、RBC、FFP 和血小板。观察到的与预期风险图显示全模型和风险评估工具具有很强的校准；在每个预期风险百分位中，观察到的与预期输血风险之间的绝对差异<10.8%。输血风险评估预测的输血概率与总输血量呈强非线性相关（P<0.0001）。
这些用于 CABG 围手术期输血的强大且校准良好的风险评估工具可以为外科医生提供有关患者风险以及他们预期需要的 RBC、FFP 和血小板单位数量的信息。这可以帮助优化结果并提高血液制品的有效利用。
