Preoperative type and crossmatch is often routinely ordered before elective endovascular aneurysm repair (EVAR), but the cost of this practice is high, and transfusion is rare. We therefore aimed to stratify patients by their risk of transfusion to identify a cohort in whom a type and screen would be sufficient. We queried the targeted vascular module of the National Surgical Quality Improvement Program database for all elective EVARs from 2011 to 2015. We included only infrarenal aneurysms and excluded ruptured aneurysms and patients who received a transfusion within 72 hours preoperatively. Two-thirds of the cases were randomly assigned to a prediction cohort and one-third to a validation cohort. We created and subsequently validated a risk model for transfusion within the first 24 hours of surgery (including intraoperatively), using logistic regression. Between 2011 and 2015, 4875 patients underwent elective infrarenal EVAR, of which only 221 (4.5%) received a transfusion within 24 hours of surgery. The frequency of transfusion over the study period declined monotonously from 6.5% in 2011 to 3.2% in 2015. The factors independently associated with transfusion were preoperative hematocrit <36% (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.1-5.4; P < .001), aortic diameter (per cm increase: OR, 1.2; 95% CI, 1.03-1.4; P = .02), preoperative dependent functional status (OR, 2.5; 95% CI, 1.1-5.5; P = .03), and chronic obstructive pulmonary disease (OR, 1.7; 95% CI, 1.04-2.9; P = .04). A risk-prediction model based on these criteria (Table) produced a C statistic of 0.69 in the prediction cohort and 0.76 in the validation cohort and a Hosmer-Lemeshow goodness of fit of 0.62 and 0.14, respectively. A score of <3 of 9, corresponding to a <5% probability of transfusion, would avoid preoperative type and crossmatch in 86% of patients. Of the 4203 patients (86%) with a hematocrit >36, only six (0.1%) had a risk score >3. Perioperative transfusion for EVAR is becoming increasingly uncommon and is predicted well by a transfusion risk score, or simply a hematocrit of <36. Application of this risk score would avoid unnecessary type and crossmatch in the majority of patients, leading to significant savings in both time and cost.TablePreoperative risk scoreCriteriaPointsTotal pointsRisk of transfusion (%)Cumulative frequency (%)Hematocrit01.9741.54 <30513.0278.91 30-36324.6286.15 ≥36036.9991.02410.4596.12Diameter515.3497.99 >5.51621.9699.36 ≤5.50730.4099.75840.4199.88COPD951.29100 Yes1 No0Dependent functional status Yes2 No0COPD, Chronic obstructive pulmonary disease. Open table in a new tab
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