A directional needle with a closed pencil-point tip and a distal side hole was developed to permit antegrade guide wire placement by way of a 90 degrees puncture angle. It has been used in over 25 patients without technical difficulties or complications. It has been very effective for catheterization of the superficial femoral artery for angioplasty, diagnostic studies, and chemotherapy infusion, providing easy antegrade access in patients in whom the traditional antegrade approach may be difficult.
Methods: TRIPOD guidelines were followed. A validation cohort (VC) was created with the 2014 hepatectomy ACS-NSQIP dataset. Characteristics of the VC and development cohort (DC) were compared. Risk groups for RBCT within 72 hours of surgery were created using anemia (hematocrit 36%), major liver resection (4 segments) and primary liver malignancy according to the TRS. The association between TRS variables and RBCT was examined with multivariable logistic regression. Area under the receiver operating characteristic curve (AUROC) assessed discrimination. HosmereLemeshow test for goodness of fit assessed calibration. Results: Of 3064 hepatectomies in VC, 18.9% received RBCT, compared to 23.3% in DC. The TRS stratified patients from low (8.5%) to very high risk (40.6%) of RBCT (Figure 1). All TRS variables were independently associated with RBCT in VC and DC. The final TRS was associated with RBCT in VC (odds ratio OR: 2.23; 95% confidence interval 95% CI: 1.99e2.51) and DC (OR 2.29; 95% CI 1.92e2.73). AUROC was 0.68 (95% CI 0.66e 0.70) in VC compared to 0.66 (95% CI 0.63e0.69) in DC. HosmereLemeshow test and calibration curves supported good predictive performance of the model in VC. Conclusion: The TRS adequately discriminated risk of RBCT in an external sample of patients undergoing hepatectomy. It provides a simple method to identify pre-operatively patients at high transfusion risk. Tailored patient blood management initiatives can be utilized to reduce the use of RBCT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.