title: Three-point transfusion risk score in hepatectomy.
abstract: BACKGROUND
  Perioperative red blood cell transfusions are required in up to 23 per cent of patients undergoing hepatectomy. Previous research has developed three transfusion risk scores to assess risk of perioperative red blood cell transfusion. Here, the performance of these transfusion risk scores was evaluated in a multicentre cohort of patients who underwent hepatectomy and compared with that of a simplified transfusion risk score.
  
  
  METHODS
  A database of patients undergoing hepatectomy at four specialized centres between 2008 and 2012 was developed. External validity was assessed by discrimination and calibration. Discrimination was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Calibration was evaluated by the degree of agreement between predicted and actual red blood cell transfusion probabilities. A simplified transfusion risk score using variables common to the three models was created, and discrimination and calibration were evaluated.
  
  
  RESULTS
  There were 1287 patients included in this study, with 341 (26·5 per cent) receiving a red blood cell transfusion. Discriminative ability was similar between the three transfusion risk scores, with AUCs of 0·66-0·68 and good calibration. A new three-point risk score was developed based on factors present in all models: haemoglobin 12·5 g/dl or less, primary liver malignancy and major resection (at least 4 segments). Discriminative ability and calibration of the three-point model were similar to those of the three existing models, with an AUC of 0·66.
  
  
  CONCLUSIONS
  The three-point transfusion risk score simplifies assessment of perioperative transfusion risk in hepatectomy without sacrificing predictive ability.
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Lemke
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: C H L
authors.initials: CH
authors.lastname: Law
authors.affiliation: Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Hepatobiliary Surgery, Division of General Surgery, London Health Sciences Centre, University of Western Ontario, London, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Tun Abraham
authors.affiliation: Hepatobiliary Surgery, Division of General Surgery, London Health Sciences Centre, University of Western Ontario, London, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Hernandez Alejandro
authors.affiliation: Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-0192-4080
authors.initials: S
authors.lastname: Bennett
authors.affiliation: Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Martel
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Karanicolas
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D019990:Perioperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors