PMID- 30240655
OWN - NLM
STAT- In-Data-Review
LR  - 20181125
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
VI  - 219
IP  - 6
DP  - 2018 Dec
TI  - A preoperative risk score to predict red blood cell transfusion in patients
      undergoing hysterectomy for ovarian cancer.
PG  - 598.e1-598.e10
LID - S0002-9378(18)30759-2 [pii]
LID - 10.1016/j.ajog.2018.09.011 [doi]
AB  - BACKGROUND: Patients with ovarian cancer experience a high rate of anemia
      throughout their treatment course, with rates that range from 19-95%. Blood
      transfusions offer symptom relief but may be costly, are limited in supply, and
      have been associated with worse 30-day surgical morbidity and mortality rates.
      OBJECTIVE: The purpose of this study was to identify risk factors for blood
      transfusion with packed red blood cell and to develop a transfusion risk score to
      identify patients who undergo surgery for ovarian cancer and who are at lowest
      risk for a blood transfusion. Our aim was to help clinicians identify those
      patients who may not require a crossmatch to encourage resource use and
      cost-savings. STUDY DESIGN: This is a retrospective database cohort study of 3470
      patients who underwent hysterectomy for ovarian cancer with the use the National 
      Surgical Quality Improvement Program database from 2014-2016. The association
      between risk factors with respect to 30-day postoperative blood transfusion was
      modeled with the use of logistic regression. A risk score to predict blood
      transfusion was created. RESULTS: Eight hundred ninety-one (25.7%) patients
      received a blood transfusion. In multivariate analysis, blood transfusion was
      associated independently with age (odds ratio, 1.90, P<.01), African American
      race (odds ratio, 2.30; P<.01), ascites (odds ratio, 1.89; P=.02), preoperative
      hematocrit level <30% (odds ratio, 10.70; P<.01), preoperative platelet count
      >400x10(9)/L (odds ratio, 1.75; P<.01), occurrence of disseminated cancer (odds
      ratio, 1.71; P<.01), open surgical approach (odds ratio, 7.88; P<.01), operative 
      time >3 hours (odds ratio, 2.19; P<.01), and additional surgical procedures that 
      included large bowel resection (odds ratio, 4.23; P<.01), bladder/ureter
      resection (odds ratio, 1.69; P=.02), and pelvic exenteration (P=.02). A
      preoperative risk score that used age, race, ascites, preoperative hematocrit
      level, platelets, presence of disseminated cancer, planned hysterectomy approach,
      and procedures accurately predicted blood transfusion with good discriminatory
      ability (C-statistic=0.80 [P<.001]; C-statistic=0.69 [P<.001] for derivation and 
      validation datasets, respectively) and calibration (Hosmer-Lemeshow
      goodness-of-fit, P=.081; P=.56 for derivation and validation datasets,
      respectively). CONCLUSION: Patients who undergo hysterectomy for ovarian cancer
      experience a high incidence of blood transfusions in the perioperative period.
      Preoperative risk factors and planned surgical procedures can be used in our
      transfusion risk score to help predict anticipated blood requirements.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Ackroyd, Sarah A
AU  - Ackroyd SA
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA. Electronic address:
      Sarah.Ackroyd@tuhs.temple.edu.
FAU - Brown, Jennifer
AU  - Brown J
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
FAU - Houck, Karen
AU  - Houck K
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
FAU - Chu, Christina
AU  - Chu C
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
FAU - Mantia-Smaldone, Gina
AU  - Mantia-Smaldone G
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
FAU - Rubin, Stephen
AU  - Rubin S
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
FAU - Hernandez, Enrique
AU  - Hernandez E
AD  - Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple
      University Hospital, Philadelphia, PA; Division of Gynecologic Oncology, Fox
      Chase Cancer Center, Philadelphia, PA.
LA  - eng
PT  - Journal Article
DEP - 20180918
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
OTO - NOTNLM
OT  - hysterectomy
OT  - ovarian cancer
OT  - transfusion
EDAT- 2018/09/22 06:00
MHDA- 2018/09/22 06:00
CRDT- 2018/09/22 06:00
PHST- 2018/06/11 00:00 [received]
PHST- 2018/09/04 00:00 [revised]
PHST- 2018/09/10 00:00 [accepted]
PHST- 2018/09/22 06:00 [pubmed]
PHST- 2018/09/22 06:00 [medline]
PHST- 2018/09/22 06:00 [entrez]
AID - S0002-9378(18)30759-2 [pii]
AID - 10.1016/j.ajog.2018.09.011 [doi]
PST - ppublish
SO  - Am J Obstet Gynecol. 2018 Dec;219(6):598.e1-598.e10. doi:
      10.1016/j.ajog.2018.09.011. Epub 2018 Sep 18.