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Risk of Transfusion in Isolated Coronary Artery Bypass Graft: Models Developed From The Society of Thoracic Surgeons
James R Edgerton1, Giovanni Filardo2, Benjamin D Pollock3
1Baylor Scott & White Health, Dallas, Texas; Division of Cardiothoracic Surgery, Washington University in St. Louis, Barnes Jewish Hospital, St Louis, Missouri.
Insights
New risk assessments predict perioperative transfusion needs in coronary artery bypass graft (CABG) surgery, aiding clinical management and efficient blood product use.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Perioperative blood transfusion after coronary artery bypass graft (CABG) surgery is linked to adverse outcomes and increased costs.
- Developing predictive tools for transfusion probability and volume is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To develop and validate risk assessment tools for predicting the likelihood and volume of perioperative transfusions in CABG patients.
- To improve clinical management and resource utilization by providing accurate transfusion risk predictions.
Main Methods:
- Analysis of 1,266,545 isolated CABG operations from 2008-2016 using The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
- Development of predictive models for perioperative transfusion of any blood product, red blood cells (RBC), fresh frozen plasma (FFP), or platelets.
- Creation of a rapid risk score using least absolute shrinkage and selection operator (LASSO) model selection based on five key variables.
Main Results:
- Full models achieved C statistics ranging from 0.707 to 0.815, while rapid risk assessments showed C statistics from 0.661 to 0.785.
- Both full models and rapid risk assessments demonstrated strong calibration, with absolute differences between observed and expected transfusion risks below 10.8%.
- Predicted probabilities of transfusion were strongly associated with the total number of units transfused (P < .0001).
Conclusions:
- Validated risk assessment tools for perioperative transfusion in CABG surgery are now available.
- These tools can inform surgeons about individual patient risks and expected blood product requirements (RBC, FFP, platelets).
- Implementation can lead to optimized patient outcomes and more efficient blood product management.
Background:
Perioperative blood transfusion is associated with adverse outcomes and higher costs after coronary artery bypass graft (CABG) surgery. We developed risk assessments for patients' probability of perioperative transfusion and the expected transfusion volume to improve clinical management and resource use.
Methods:
Among 1,266,545 consecutive (2008-2016) isolated CABG operations in The Society of Thoracic Surgeons Adult Cardiac Surgery Database, 657,821 (51.9%) received perioperative transfusions of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate, and/or platelets. We developed "full" models to predict perioperative transfusion of any blood product, and of RBC, FFP, or platelets. Using least absolute shrinkage and selection operator model selection, we built a rapid risk score based on 5 variables (age, body surface area, sex, preoperative hematocrit, and use of intra-aortic balloon pump).
Results:
C statistics for the full model were 0.785, 0.815, 0.707, and 0.699 for any blood product, RBC, FFP, and platelets, respectively. C statistics for rapid risk assessments were 0.752, 0.785, 0.670, and 0.661 for any blood product, RBC, FFP, and platelets, respectively. The observed vs expected risk plots showed strong calibration for full models and risk assessment tools; absolute differences between observed and expected risks of transfusion were <10.8% in each percentile of expected risk. Risk assessment-predicted probabilities of transfusion were strongly and nonlinearly associated (P < .0001) with total units transfused.
Conclusions:
These robust and well-calibrated risk assessment tools for perioperative transfusion in CABG can inform surgeons regarding patients' risks and the number of RBC, FFP, and platelets units they can expect to need. This can aid in optimizing outcomes and increasing efficient use of blood products.
