Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery

Abdelsattar, Zaid M.; Hendren, Samantha; Wong, Sandra L.; Campbell, Darrell A.; Henke, Peter K.

doi:10.1097/sla.0000000000001264

Cited by 51 publications

(48 citation statements)

References 37 publications

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“…However, transfusion is particularly harmful in patients without postoperative anemia (hemoglobin C 9.0 g/dL), with a fourfold increased risk of 30-day death [4]. In addition, patients receiving a postoperative transfusion also have significantly increased risks for 30-day mortality and morbidity, and infectious complications after noncardiac surgery [5]. Thus, we believe that a more persuasive result would have been presented, if perioperative hemoglobin levels and transfusion had been included in data analysis of this study.…”

Section: Dear Editormentioning

confidence: 99%

Assessing relationship between admission blood glucose level and prognosis after emergency noncardiac surgery

Xue

Liu

et al. 2015

Intern Emerg Med

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Section: Dear Editormentioning

confidence: 99%

Assessing relationship between admission blood glucose level and prognosis after emergency noncardiac surgery

Xue

Liu

et al. 2015

Intern Emerg Med

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“…8 Blood transfusions are also correlated with adverse postoperative outcomes and their associated costs, including septic, wound, thromboembolic, and pulmonary complications; longer hospital stays; higher hospital charges; and patient death. [9][10][11] The average risk of transfusion is variable in gynecology and ranges from 0.01% for operative hysteroscopy, 2-5% for operative laparoscopy, 0.3-11% for hysterectomy, 21% for myomectomy, and up to 78% for cytoreductive surgery. [12][13][14][15][16][17][18] However, the overall average risk of a woman requiring a blood transfusion after gynecologic surgery is low making routine testing a high-cost, low-value decision.…”

Section: Introductionmentioning

confidence: 99%

A model to predict risk of blood transfusion after gynecologic surgery

Stanhiser

Chagin

Jelovsek

2017

American Journal of Obstetrics and Gynecology

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BACKGROUND:A model that predicts a patient's risk of receiving a blood transfusion may facilitate selective preoperative testing and more efficient perioperative blood management utilization. OBJECTIVE: We sought to construct and validate a model that predicts a patient's risk of receiving a blood transfusion after gynecologic surgery. STUDY DESIGN: In all, 18,319 women who underwent gynecologic surgery at 10 institutions in a single health system by 116 surgeons from January 2010 through June 2014 were analyzed. The data set was split into a model training cohort of 12,219 surgeries performed from January 2010 through December 2012 and a separate validation cohort of 6100 surgeries performed from January 2013 through June 2014. In all, 47 candidate risk factors for transfusion were collected. Multiple logistic models were fit onto the training cohort to predict transfusion within 30 days of surgery. Variables were removed using stepwise backward reduction to find the best parsimonious model. Model discrimination was measured using the concordance index. The model was internally validated using 1000 bootstrapped samples and temporally validated by testing the model's performance in the validation cohort. Calibration and decision curves were plotted to inform clinicians about the accuracy of predicted probabilities and whether the model adds clinical benefit when making decisions. RESULTS: The transfusion rate in the training cohort was 2% (95% confidence interval, 1.72e2.22). The model had excellent discrimination and calibration during internal validation (bias-corrected concordance index, 0.906; 95% confidence interval, 0.890e0.928) and maintained accuracy during temporal validation using the separate validation cohort (concordance index, 0.915; 95% confidence interval, 0.872e0.954). Calibration curves demonstrated the model was accurate up to 40% then it began to overpredict risk. The model provides superior net benefit when clinical decision thresholds are between 0-50% predicted risk. CONCLUSION: This model accurately predicts a patient's risk of transfusion after gynecologic surgery facilitating selective preoperative testing and more efficient perioperative blood management utilization.

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“…Prior studies have evaluated the utility of video recordings for subsequent evaluation and debriefing (8–11) and for improving self-assessment (12–14), but the vast majority studied simulated surgical scenarios or physical examination skills rather than operative videos from patient procedures. Video-based coaching can be a useful tool for providing individualized, targeted feedback for trainees (15), and reinforces intraoperative teaching points (16) in a less stressful environment and has also been shown to improve skill acquisition (17). Nevertheless, video review of unedited surgical procedures is labor-intensive and time-consuming.…”

Section: Introductionmentioning

confidence: 99%

The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment

Herrera‐Almario

Kirk

Guerrero

et al. 2016

The American Journal of Surgery

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Background Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident’s laparoscopic performance differ and whether video review changes assessments. Methods Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video-recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7–10 days later by both resident and attending. Scores were compared using t- tests. Results Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both prior to and after video review. Resident scores did not change significantly after video review. Conclusions Attending and resident self-assessment of laparoscopic skills differ and subsequent video review doesn’t significantly affect GOALS scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment.

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Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery

Cited by 51 publications

References 37 publications

Assessing relationship between admission blood glucose level and prognosis after emergency noncardiac surgery

Assessing relationship between admission blood glucose level and prognosis after emergency noncardiac surgery

A model to predict risk of blood transfusion after gynecologic surgery

The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment

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