A multivariable model for predicting the need for blood transfusion in patients undergoing first-time elective coronary bypass graft surgery.
BACKGROUND
The incidence of blood transfusion in coronary artery bypass graft (CABG) surgery remains high. Preoperative identification of those at high risk for requiring blood will allow for the cost-effective use of some blood conservation modalities. Multivariable analysis techniques were used in this study to develop a prediction rule for such a purpose.


METHODS
Data were prospectively collected for all patients undergoing elective first-time CABG surgery from January 1997 to September 1998 at a tertiary-care teaching hospital (n = 1007). The prediction rule was developed on the first two-thirds of the sample by using logistic regression methods to examine the relationship of patient demographics, comorbidities, and preoperative Hb with perioperative blood transfusion. The remaining one-third of the sample was used to validate the rule.


RESULTS
The transfusion rate was 29.4 percent. The prediction rule included preoperative Hb (g/dL, OR 0.928, p<0.0001), weight (kg, OR 0.938, p<0.0001), age (years, OR 1.037, p<0.01), and sex (male/female, OR 0.493, p<0.01); receiver operating characteristic = 0.86. When externally validated, the rule had a sensitivity of 82.1 percent and a specificity of 63.6 percent (at a selected probability cutoff).


CONCLUSIONS
A simple and valid prediction rule is developed for predicting the risk of blood transfusion in patients undergoing first-time elective CABG surgery.
Karkouti
K
K
Department of Anesthesia, University Health Network, Toronto General Hospital, Centre for Research in Women's Health, Ontario, Canada. keyvan.karkouti@uhn.on.ca
Cohen
M M
MM
McCluskey
S A
SA
Sher
G D
GD
D000368:Aged; D000465:Algorithms; D001185:Artificial Intelligence; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors