title: Trends and risk factors for transfusion in hepatopancreatobiliary surgery.
abstract: BACKGROUND
  Patient-specific factors impacting the need for possible perioperative blood transfusions have not been examined in patients undergoing hepatopancreatobiliary (HPB) procedures. We sought to define the overall utilization of blood transfusions for HPB surgery stratified by procedure type, as well as identify patient-level risk factors for transfusion.
  
  
  METHODS
  Hepatic and pancreatic resections were selected from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program's public use files. Transfusion utilization, risk factors, temporal trends, and outcomes were assessed using regression models. Missing data were addressed using multiple imputation.
  
  
  RESULTS
  Twenty-six thousand eight hundred twenty-seven patients met the inclusion criteria. There were 16,953 pancreas cases (distal pancreatectomy (31.2%), pancreaticoduodenectomy (65.8%), total pancreatectomy (3.0%)), and 9,874 liver cases (wedge resection (60.0%), hemi-hepatectomy (30.1%), trisegmentectomy (9.9%)). Overall, 25.7% patients received a perioperative transfusion. Transfusion rates varied by operation type (hepatic wedge resection 18.7%, lobectomy 31.3%, trisegmentectomy 39.8%, distal pancreatectomy 19.8%, Whipple 28.7%, total pancreatectomy 43.6%, p < 0.001). On multivariate analysis, several patient-level factors were strongly associated with the risk of transfusion: preoperative hematocrit <36% (risk ratios (RR) 1.99, 95% CI 1.91-2.08), preoperative albumin <3.0 g/dL (RR 1.25, 95% CI 1.19-1.31), American Society of Anesthesiologists (ASA) class IV (RR 1.24, 95% CI 1.16-1.33), and anticoagulation/bleeding disorder (RR 1.26, 95% CI 1.15-1.38) (all p < 0.001). Patients with any one of these high-risk factors had an over twofold increased risk of perioperative transfusion (RR 2.31, 95% CI 2.21-2.40, p < 0.001).
  
  
  CONCLUSIONS
  There are large differences in the incidence of transfusion among patients undergoing HPB procedures. While the type of HPB procedure was associated with the risk of transfusion, patient-level factors-including preoperative hematocrit and albumin, ASA classification, and history of anticoagulation/bleeding disorder-were as important.
authors: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors: Donald J
authors: DJ
authors: Lucas
authors: Katherine I
authors: KI
authors: Schexneider
authors: Matthew
authors: M
authors: Weiss
authors: Christopher L
authors: CL
authors: Wolfgang
authors: Steven M
authors: SM
authors: Frank
authors: Kenzo
authors: K
authors: Hirose
authors: Nita
authors: N
authors: Ahuja
authors: Martin
authors: M
authors: Makary
authors: John L
authors: JL
authors: Cameron
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000150:complications; D001803:Blood Transfusion / Q000639:trends*; D005260:Female; D006400:Hematocrit; D006498:Hepatectomy / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000639:trends*; D016577:Pancreaticoduodenectomy / Q000639:trends*; D062072:Patient Acuity; D019990:Perioperative Care / Q000639:trends; D012307:Risk Factors; D012709:Serum Albumin
chemical_list: D012709:Serum Albumin