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Ackroyd SA , Brown J , Houck K , Chu C , Mantia-Smaldone G , Rubin S , Hernandez E
A preoperative risk score to predict red blood cell transfusion in patients undergoing hysterectomy for ovarian cancer
Am J Obstet Gynecol. 2018 Dec;219(6) :598 e1-598 e10
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BACKGROUND: Patients with ovarian cancer experience a high rate of anemia throughout their treatment course, with rates ranging from 19% to 95%. Blood transfusions offer symptom relief but may be costly, are limited in supply, and have been associated with worse 30-day surgical morbidity and mortality. OBJECTIVE: To identify risk factors for blood transfusion with packed red blood cell (pRBC) and develop a transfusion risk score to identify patients undergoing surgery for ovarian cancer who are at lowest risk for a blood transfusion. Our aim is to help clinicians identify those who may not require a crossmatch to encourage resource utilization and cost savings. STUDY DESIGN: This is a retrospective database cohort study of 3,470 patients who underwent hysterectomy for ovarian cancer utilizing the National Surgical Quality Improvement Program database (NSQIP) from 2014-2016. The association between risk factors with respect to 30-day postoperative blood transfusion was modeled using logistic regression. A risk score to predict blood transfusion was created. RESULTS: 891 (25.7%) patients received a blood transfusion. In multivariate analysis, blood transfusion was independently associated with age (OR 1.90, p<0.01), African American race (OR 2.30, p<0.01), ascites (OR 1.89, p=0.02), preoperative hematocrit <30% (OR 10.70, p<0.01), preoperative platelet count >400 (x10(9)/L) (OR 1.75, p<0.01), occurrence of disseminated cancer (OR 1.71, p<0.01), open surgical approach (OR 7.88, p<0.01), operative time >3 hours (OR 2.19, p<0.01) and additional surgical procedures including: large bowel resection (OR 4.23, p<0.01), bladder/ureter resection (OR 1.69, p=0.02), and pelvic exenteration (p=0.02). A preoperative risk score using age, race, ascites, preoperative hematocrit and platelets, presence of disseminated cancer, planned hysterectomy approach and procedures, accurately predicted blood transfusion with good discriminatory ability (C-statistic = 0.80, p<0.001, C-statistic = 0.69, p<0.001 for derivation and validation datasets, respectively) and calibration (Hosmer-lemeshow goodness-of-fit p=0.081, p=0.56 for derivation and validation datasets, respectively). CONCLUSIONS: Patients undergoing hysterectomy for ovarian cancer experience a high incidence of blood transfusions in the perioperative period. Preoperative risk factors and planned surgical procedures can be used in our transfusion risk score to help predict anticipated blood requirements.
1097-6868 Ackroyd, Sarah A Brown, Jennifer Houck, Karen Chu, Christina Mantia-Smaldone, Gina Rubin, Stephen Hernandez, Enrique Journal Article United States Am J Obstet Gynecol. 2018 Dec;219(6):598.e1-598.e10. doi: 10.1016/j.ajog.2018.09.011. Epub 2018 Sep 18.