Predictors of blood transfusion requirement in elective liver resection.
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.
Cockbain
Andrew J
AJ
Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Beckett Street, Leeds, UK.
Masudi
Tahir
T
Lodge
J Peter A
JP
Toogood
Giles J
GJ
Prasad
K Raj
KR
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