Canadian Journal of Anesthesia

, Volume 53, Issue 8, pp 781–794

Prediction of massive blood transfusion in cardiac surgery

  • Keyvan Karkouti
  • Rachel O’Farrell
  • Terrence M. Yau
  • W. Scott Beattie
  • Reducing Bleeding in Cardiac Surgery (RBC) Research Group
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

In cardiac surgery with cardiopulmonary bypass (CPB), excessive blood loss requiring the transfusion of multiple red blood cell (RBC) units is a common complication that is associated with significant morbidity and mortality. The objective of this study was to develop a prediction rule for massive blood transfusion (MBT) that could be used to optimize the management of, and research on, at-risk patients.

Methods

Data were collected prospectively over the period from 2000 to 2005, on patients who underwent surgery with CPB at one hospital. Patients who received ≥ five units of RBC within one day of surgery were classified as MBT. Logistic regression was used to appropriately select and weigh perioperative variables in the prediction rule, which was developed on the initial 60% of the sample and validated on the remaining 40%.

Results

Of the 10,667 patients included, 925 (8.7%) had MBT. The clinical prediction rule included 12 variables (listed in order of predictive value: CPB duration, preoperative hemoglobin concentration, body surface area, nadir CPB hematocrit, previous sternotomy, preoperative shock, preoperative platelet count, urgency of surgery, age, surgeon, deep hypothermic circulatory arrest, and type of procedure) and was highly discriminative (c-index = 0.88). In the validation set, those classified as low-, moderate-, and high-risk by a simple risk score derived from the prediction rule had a 5%, 27%, and 58% chance of MBT, respectively.

Conclusion

A clinical prediction rule was developed that accurately identified patients at low-risk or high-risk for MBT. Studies are needed to determine the external generalizability and clinical utility of the prediction rule.

La prédiction d’une transfusion massive en cardiochirurgie

Résumé

Objectif

En cardiochirurgie avec circulation extracorporelle (CEC), une perte de sang excessive exigeant la transfusion de multiples unités de culots globulaires (CG) est une complication fréquente associée à une morbidité et à une mortalité significatives. L’objectifde notre étude était d’élaborer une règle de prédiction pour la transfusion massive (TM) qui pourrait être utilisée pour optimaliser la recherche sur les patients à risque, et leur traitement.

Méthode

Les données prospectives ont été recueillies sur les patients qui ont subi une opération avec CEC dans un hôpital entre 2000 et 2005. Les patients ayant reçu ≥ cinq unités de CG en moins d’un jour postopératoire ont été classés comme TM. La régression logistique a permis de choisir et pondérer convenablement les variables périopératoires de la règle de prédiction qui a été élaborée d’après les premiers 60 % de l’échantillon et validée sur les 40 % restant.

Résultats

Des 10 667 patients inclus, 925 (8,7 %) avaient eu une TM. La règle de prédiction clinique incluait 12 variables (présentées par ordre de valeur prédictive: durée de la CEC, concentration d’hémoglobine préopératoire, surface corporelle, hématocrite minimal de la CEC, sternotomie antérieure, choc

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Keyvan Karkouti
    • 1
    • 2
  • Rachel O’Farrell
    • 1
    • 4
  • Terrence M. Yau
    • 3
  • W. Scott Beattie
    • 1
  • Reducing Bleeding in Cardiac Surgery (RBC) Research Group
  1. 1.Department of AnesthesiaUniversity Health Network, Toronto General HospitalTorontoCanada
  2. 2.Department of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Department of Cardiac SurgeryUniversity of TorontoTorontoCanada
  4. 4.Department of HematologyUniversity Health NetworkCanada

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