title: Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery.
abstract: BACKGROUND
  Predictive tools assessing risk of transfusion have not been evaluated extensively among patients undergoing complex gastrointestinal surgery. In this study preoperative variables associated with blood transfusion were incorporated into a nomogram to predict transfusion following hepatopancreaticobiliary (HPB) or colorectal surgery.
  
  
  METHODS
  A nomogram to predict receipt of perioperative transfusion was developed using a cohort of patients who underwent HPB or colorectal surgery between January 2009 and December 2014. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic (ROC) curve and internal validation performed via bootstrap resampling.
  
  
  RESULTS
  Among 4961 patients undergoing either a HPB (56·3 per cent) or colorectal (43·7 per cent) resection, a total of 1549 received at least 1 unit of packed red blood cells, giving a perioperative transfusion rate of 31·2 per cent. On multivariable analysis, age 65 years and over (odds ratio (OR) 1·52), race (versus white: black, OR 1·58; Asian, OR 1·86), preoperative haemoglobin 8·0 g/dl or less (versus over 12·0 g/dl: OR 26·79), preoperative international normalized ratio more than 1·2 (OR 2·44), Charlson co-morbidity index score over 3 (OR 1·86) and procedure type (versus colonic surgery: major hepatectomy, OR 1·71; other pancreatectomy, OR 2·12; rectal surgery, OR 1·39; duodenopancreatectomy, OR 2·65) were associated with a significantly higher risk of transfusion and were included in the nomogram. A nomogram was constructed to predict transfusion using these seven variables. Discrimination and calibration of the nomogram revealed good predictive abilities (area under ROC curve 0·756).
  
  
  CONCLUSIONS
  The nomogram predicted blood transfusion in major HPB and colorectal surgery.
authors.affiliation: Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: F
authors.initials: F
authors.lastname: Bagante
authors.affiliation: Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: F
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: L
authors.initials: L
authors.lastname: Xu
authors.affiliation: Departments of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: J O
authors.initials: JO
authors.lastname: Wasey
authors.affiliation: Departments of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Johnson
authors.affiliation: Departments of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Frank
authors.affiliation: Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003106:Colon / Q000601:surgery; D003661:Decision Support Techniques; D013505:Digestive System Surgical Procedures; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care / Q000706:statistics & numerical data*; D057234:Preoperative Period; D012372:ROC Curve; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult