title: Predictors of blood transfusion requirement in elective liver resection.
abstract: BACKGROUND
  Liver resection remains major surgery frequently requiring intra-operative blood transfusion. Patients are typically over cross-matched, and with blood donor numbers falling, cross-matching and transfusion policies need rationalizing.
  
  
  OBJECTIVE
  To identify predictors of peri-operative blood transfusion.
  
  
  METHODS
  A retrospective review of elective hepatic resections over a 4-year period was performed. Twenty-six variables including clinicopathological variables and intra-operative data were collated, together with the number of units of blood cross-matched and transfused in the immediate peri-operative period (48 h). Multivariate regression analysis was performed to identify independent predictors of blood transfusion, and a Risk Score for transfusion constructed.
  
  
  RESULTS
  Five hundred and eighty-nine patients were included in the study, and were cross-matched with a median 10 units of blood. Seventeen per cent of patients received a blood transfusion; median transfusion when required was 2 units. Regression analysis identified seven factors predictive of transfusion: haemoglobin <12.5 g/dL, pre-operative biliary drainage, coronary artery disease, largest tumour >3.5 cm, cholangiocarcinoma, redo resection and extended resection (5+ segments). Patients were stratified into high or low risk of transfusion based on Risk Score with a sensitivity of 73% [receiver-operating characteristic (ROC) 0.77].
  
  
  CONCLUSIONS
  Patients undergoing elective liver resection are over-cross-matched. Patients can be classified into high and low risk of transfusion using a Risk Score, and cross-matched accordingly.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Beckett Street, Leeds, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cockbain
authors.forename: Tahir
authors.initials: T
authors.lastname: Masudi
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: K Raj
authors.initials: KR
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001788:Blood Grouping and Crossmatching; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult