Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery

BackgroundPredictive tools assessing risk of transfusion have not been evaluated extensively among patients undergoing complex gastrointestinal surgery. In this study preoperative variables associated with blood transfusion were incorporated into a nomogram to predict transfusion following hepatopancreaticobiliary (HPB) or colorectal surgery. MethodsA nomogram to predict receipt of perioperative transfusion was developed using a cohort of patients who underwent HPB or colorectal surgery between January 2009 and December 2014. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic (ROC) curve and internal validation performed via bootstrap resampling. ResultsAmong 4961 patients undergoing either a HPB (563 per cent) or colorectal (437 per cent) resection, a total of 1549 received at least 1unit of packed red blood cells, giving a perioperative transfusion rate of 312 per cent. On multivariable analysis, age 65years and over (odds ratio (OR) 152), race (versus white: black, OR 158; Asian, OR 186), preoperative haemoglobin 80g/dl or less (versus over 120g/dl: OR 2679), preoperative international normalized ratio more than 12 (OR 244), Charlson co-morbidity index score over 3 (OR 186) and procedure type (versus colonic surgery: major hepatectomy, OR 171; other pancreatectomy, OR 212; rectal surgery, OR 139; duodenopancreatectomy, OR 265) were associated with a significantly higher risk of transfusion and were included in the nomogram. A nomogram was constructed to predict transfusion using these seven variables. Discrimination and calibration of the nomogram revealed good predictive abilities (area under ROC curve 0756). ConclusionThe nomogram predicted blood transfusion in major HPB and colorectal surgery.