A transfusion risk stratification score to facilitate quality management in cardiopulmonary bypass

Abstract

BackgroundOur previous showed that a blood management program in the cardiopulmonary bypass (CPB) department, reduced red blood cell (RBC) transfusion and complications, but assessing transfusion practice solely based on transfusion rates was insufficient. This study aimed to design a risk stratification score to predict perioperative RBC transfusion to guide targeted measures for on‐pump cardiac surgery patients.Study Design and MethodsWe analyzed data from 42,435 adult cardiac patients. Eight predictors were entered into the final model including age, sex, anemia, New York Heart Association classification, body surface area, cardiac surgery history, emergency surgery, and surgery type. We then simplified the score to an integer‐based system. The area under the receiver operating characteristic curve (AUC), Hosmer–Lemeshow goodness‐of‐fit test, and a calibration curve were used for its performance test. The score was compared to existing scores.ResultsThe final score included eight predictors. The AUC for the model was 0.77 (95% CI, 0.76–0.77) and 0.77 (95% CI, 0.76–0.78) in the training and test set, respectively. The calibration curves showed a good fit. The risk score was finally grouped into low‐risk (score of 0–13 points), medium‐risk (14–19 points), and high‐risk (more than 19 points). The score had better predictive power compared to the other two existing risk scores.DiscussionWe developed an effective risk stratification score with eight variables to predict perioperative RBC transfusion for on‐pump cardiac surgery. It assists perfusionists in proactively preparing blood conservation measures for high‐risk patients before surgery.

A modified low-priming cardiopulmonary bypass system in patients undergoing cardiac surgery with medium risk of transfusion: A randomized controlled trial

“…Furthermore, based on our center's previous data, we established the FUWAI Transfusion Risk Stratification Score [ 5 ]. The transfusion stratification was divided into three levels: low (transfusion probability less than 30 %), medium (transfusion probability 30 %–60 %), and high (transfusion probability greater than 60 %) risk.…”