Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

Abstract

Background This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products. Methods This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves. Results A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values. Conclusions A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.

Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram

“…The present study introduced perioperative parameters to develop the nomogram for predicting the blood transfusion risk. The C-index calculated by the nomogram was 0.787 and 0.763 in the training and validation sets, respectively, which indicated the highly accurate predictability of the nomogram [ 21 ]. The C-index calculated in the present paper was higher than that obtained by the previous nomogram (0.734) [ 24 ].…”

“…The C-index calculated in the present paper was higher than that obtained by the previous nomogram (0.734) [ 24 ]. The combination and predictive efficacy of the nomogram increased with C-index [ 21 ]. The present study used internal validation to calculate the C-index.…”

“…Studies have shown that good discrimination and calibration ability could be obtained through internal validation in the cohort. The high C-index was especially suitable for wide use in large sample data [ 21 ]. The nomogram in the present study achieved the best discriminatory ability with an AUC of 0.785, which was slightly higher than that of the previously established nomogram (AUC = 0.75) [ 16 ].…”

“…Blood transfusion risk could be assessed in the perioperative period by using the nomogram model, and the surgeon was well prepared with adequate blood to perform the surgery, which promoted a more reasonable allocation of blood resources [ 21 ]. Huang exhibited the efficient development and validation of the nomogram to predict blood transfusion for surgery.…”

“…The prediction accuracy and discriminant ability of the nomograms were assessed by the C-index. The range of the C-index was usually < 0.5, 0.5–0.7, 0.7–0.9, and > 0.9, representing low accuracy, moderate accuracy, high accuracy, and extreme accuracy, respectively [ 21 ]. A calibration curve was plotted to assess the actual and predicted risks of the blood transfusion nomogram.…”