Development of a nomogram for predicting perioperative blood transfusions in major hepatobiliary and colorectal surgeries: a retrospective study

Abstract

Background: Major hepatobiliary and colorectal surgeries are associated with a risk of blood transfusions. However, risk assessment tools for predicting blood transfusions have not been studied extensively among patients undergoing these types of surgeries. We evaluated the risk factors for perioperative blood transfusions in patients who underwent major hepatobiliary and colorectal surgeries and subsequently created a nomogram. Methods: Medical records of patients who underwent elective major hepatobiliary and colorectal surgeries in a single university hospital in Malaysia from 2015 to 2020 were retrospectively reviewed. A nomogram to predict transfusions risk was developed, and its discriminatory ability was tested using the area under the receiver operating characteristic (ROC) curve. Results: Data from 293 patients (61.1% male) with an average age of 59.7 years (± SD 14.51) were analysed. The prevalence of anaemia was 61.1%. A total of 127 patients (43.3%) received at least 1 unit of packed red cells transfusions. On multivariable analysis, gender (odds ratio [OR 1.646), preoperative haemoglobin of 8.0 g/dl or less (OR 0.777), Charlson Comorbidity Index score (OR 1.14) and procedure type (versus colonic surgery, major hepatectomy, OR 6.094; other pancreatomy, OR 1.487; Whipple’s procedure, OR 9.667; and anterior resection, OR 3.569) were associated with a significantly higher risk of transfusions. All 4 of these factors were included in the nomogram. The nomogram’s discrimination and calibration results showed an AUROC curve of 0.754. Conclusion: The nomogram effectively predicted the need for blood transfusions in major colorectal and hepatobiliary surgeries in our patients.