Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen”

Objective Preoperative testing for carotid endarterectomy (CEA) often includes blood typing and antibody screen (T&S). In our institutional experience, however, transfusion for CEA is rare. We assessed transfusion rate and risk factors in a national clinical database to identify a cohort of pati...

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Veröffentlicht in:Journal of vascular surgery 2016-12, Vol.64 (6), p.1711-1718
Hauptverfasser: Stangenberg, Lars, MD, PhD, Curran, Thomas, MD, MPH, Shuja, Fahad, MD, Rosenberg, Robert, MD, Mahmood, Feroze, MD, Schermerhorn, Marc L., MD
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Sprache:eng
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Zusammenfassung:Objective Preoperative testing for carotid endarterectomy (CEA) often includes blood typing and antibody screen (T&S). In our institutional experience, however, transfusion for CEA is rare. We assessed transfusion rate and risk factors in a national clinical database to identify a cohort of patients in whom T&S can safely be avoided with the potential for substantial cost savings. Methods With use of the National Surgical Quality Improvement Program database, transfusion events and timing were established for all elective CEAs in 2012-2013. Comorbidities and other characteristics were compared for patients receiving intraoperative or postoperative transfusion and those who did not. After random assignment of the total data to either a training or validation set, a prediction model for transfusion risk was created and subsequently validated. Results Of 16,043 patients undergoing CEA in 2012-2013, 276 received at least one transfusion before discharge (1.7%); 42% of transfusions occurred on the day of surgery. Preoperative hematocrit 
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2016.04.059