Premium
Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty
Author(s) -
Huang ZeYu,
Huang Cheng,
Xie JinWei,
Ma Jun,
Cao GuoRui,
Huang Qiang,
Shen Bin,
Byers Kraus Virginia,
Pei FuXing
Publication year - 2018
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14783
Subject(s) - medicine , perioperative , receiver operating characteristic , logistic regression , american society of anesthesiologists , tranexamic acid , blood transfusion , arthroplasty , area under the curve , joint arthroplasty , risk assessment , risk factor , surgery , blood loss , computer security , computer science
BACKGROUND The aim of this study was to identify the predictors of need for allogenic blood transfusion (ALBT) in primary lower limb total joint arthroplasty (TJA). STUDY DESIGN AND METHODS This study utilized a large dataset of 15,187 patients undergoing primary unilateral TJA. Risk factors and demographic information were extracted from the electronic health record. A predictive model was developed by both a random forest (RF) algorithm and logistic regression (LR). The area under the receiver operating characteristic curve (AUC‐ROC) was used to compare the accuracy of the two methods. RESULTS The rate of ALBT was 18.9% in total. Patient‐related factors associated with higher risk of an ALBT included female sex, American Society of Anesthesiologists (ASA) II, ASA III, and ASA IV. Surgery‐related risk factors for ALBT were operative time, drain use, and amount of intraoperative blood loss. Higher preoperative hemoglobin and tranexamic acid use were associated with decreased risk for ALBT. The RF model had a better predictive accuracy (area under the curve [AUC] 0.84) than the LR model (AUC, 0.77; p < 0.001). CONCLUSION The risk factors identified in the current study can provide specific, personalized perioperative ALBT risk assessment for a patient considering lower limb TJA. Furthermore, the predictive accuracy of the RF algorithm was significantly higher than that of LR, making it a potential tool for future personalized preoperative prediction of risk for perioperative ALBT.