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Risk of Transfusion in Isolated Coronary Artery Bypass Graft: Models Developed From The Society of Thoracic Surgeons Database. | LitMetric

AI Article Synopsis

  • Perioperative blood transfusions during coronary artery bypass graft (CABG) surgery can lead to negative outcomes and increased costs, prompting the development of risk assessments to better manage transfusion needs.
  • A study analyzed over 1.2 million CABG operations, finding that more than half required transfusions, and created predictive models using variables like age and preoperative hematocrit to help estimate transfusion likelihood and volume.
  • The resulting risk assessment tools showed strong accuracy in predicting transfusion needs, helping surgeons make informed decisions and optimize the use of blood products for better patient outcomes.

Article Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

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Source
http://dx.doi.org/10.1016/j.athoracsur.2024.06.022DOI Listing

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