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Predictive Model for Blood Product Use in Coronary Artery Bypass Grafting
Hasanat Sharif1, Hamza Zaheer Ansari1, Awais Ashfaq1
1Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi.
Insights
Predictors for blood transfusion in coronary artery bypass grafting (CABG) surgery were identified in a South East Asian population. Key factors include age, male gender, obesity, tobacco use, diabetes, and urgent surgical status, aiding in preoperative risk assessment.
Area of Science:
- Cardiothoracic Surgery
- Transfusion Medicine
- Clinical Prediction Modeling
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac procedure.
- Blood transfusion is frequently required during CABG, necessitating accurate prediction.
- Understanding predictors is crucial for optimizing resource allocation and patient management.
Purpose of the Study:
- To develop a clinical predictive model for blood transfusion needs in South East Asian patients undergoing CABG.
- To identify key demographic, clinical, and procedural factors associated with transfusion.
Main Methods:
- An analytical study was conducted involving adult patients undergoing on-pump CABG.
- Pre-, intra-, and postoperative variables were collected and analyzed.
- Univariate and multivariate logistic regression models were employed to determine transfusion predictors.
Main Results:
- A total of 3,550 patients underwent CABG, with a 56.4% transfusion rate.
- Significant predictors included older age, male gender, obesity, tobacco use, diabetes, prior myocardial infarction, elevated creatinine, and left main coronary artery disease.
- Urgent and emergent cases showed significantly higher transfusion rates compared to elective procedures.
Conclusions:
- Age, male gender, obesity, tobacco use, diabetes, myocardial infarction, high creatinine, and urgent/emergent surgical status are independent predictors of transfusion in CABG.
- The developed model can aid in preoperative risk stratification and patient management to improve outcomes.
Objective:
To build a clinical predictive model to determine the need for transfusing blood and its products in coronary artery bypass grafting (CABG) procedures in South East Asian population.
Study Design:
Analytical study.
Place And Duration Of Study:
Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from January 2006 to October 2014.
Methodology:
Information on pre-, intra- and postoperative variables were collected for all adult patients who underwent on-pump CABG. The patients grouped into those who received blood and its components, and those who did not. Aunivariate as well as multivariate logistic model was built to determine the predictors of transfusion.
Results:
A total of 3,550 patients underwent CABG and males were dominant in both groups (75 vs. 93%). The transfusion rate was 56.4% (n=2001). Age (adjusted OR 1.03, p < 0.001), obesity (1.50, p=0.001), tobacco use (1.29, p=0.001), and male gender (4.51, p < 0.001) found to be a stronger predictor. Among preoperative comorbidities, diabetes (1.20, p=0.016), myocardial infarction (1.22, p=0.009), preoperative creatinine (1.12, p=0.033), and left main vessel disease of > 50% (1.49, p < 0.001) were independently associated with the outcome. Compared to elective cases, transfusion rates were high in urgent and emergent cases (OR: 1.93 and 3.36 respectively, p < 0.001 for both).
Conclusion:
Age, male gender, obesity, tobacco use, diabetes, myocardial infarction, high creatinine, urgent and emergent cases were independent predictors of transfusion in CABG procedure. This model can be utilized for preoperative risk stratification of patients and their management to improve the outcomes.
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