Background: 

The identification of factors associated with perioperative red blood cell (RBC) transfusion provides an opportunity to optimize the patient and surgical plan, and to guide perioperative crossmatch and RBC orders. We examined the association among potential bleeding risk factors and RBC requirements to develop a novel predictive model for RBC transfusion in patients undergoing brain tumor surgery.

Methods: 

This retrospective study included 696 adults who underwent brain tumor surgery between 2008 and 2018. Multivariable logistic regression with backward stepwise selection for predictor selection was used during modeling. Model performance was evaluated using area under the receiver operating characteristic curve, and calibration was evaluated with Hosmer-Lemeshow goodness-of-fit χ²-estimate.

Results: 

Preoperative hemoglobin level was inversely associated with the probability of RBC transfusion (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.39-0.63; P<0.001). The need for RBC transfusion was also greater in patients who had a previous craniotomy (OR: 2.71; 95% CI: 1.32-5.57; P=0.007) and in those with larger brain tumor volume (OR: 1.01; 95% CI: 1.00-1.02; P=0.009). The relationship between number of planned craniotomy sites and RBC transfusion was not statistically significant (OR: 2.11; 95% CI: 0.61-7.32; P=0.238). A predictive model for RBC requirements was built using these 4 variables. The area under the receiver operating characteristic curve was 0.79 (95% CI: 0.70-0.87; P<0.001) showing acceptable calibration for predicting RBC transfusion requirements.

Conclusions: 

RBC requirements in patients undergoing brain tumor surgery can be estimated with acceptable accuracy using a predictive model based on readily available preoperative clinical variables. This predictive model could help to optimize both individual patients and surgical plans, and to guide perioperative crossmatch orders.

中文翻译：

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开发和评估脑肿瘤手术中红细胞需求风险的临床预测模型

背景： 

确定与围手术期红细胞 (RBC) 输血相关的因素可以优化患者和手术计划，并指导围手术期交叉配血和红细胞顺序。我们检查了潜在出血风险因素与红细胞需求之间的关联，以开发一种新的脑肿瘤手术患者红细胞输注预测模型。

方法： 

这项回顾性研究包括 696 名在 2008 年至 2018 年间接受脑肿瘤手术的成年人。在建模过程中使用多变量逻辑回归和向后逐步选择预测因子选择。使用接受者操作特征曲线下的面积评估模型性能，并使用 Hosmer-Lemeshow 拟合优度 χ ²估计评估校准。

结果： 

术前血红蛋白水平与红细胞输注概率呈负相关（比值比 [OR]：0.50；95% 置信区间 [CI]：0.39-0.63；P <0.001）。接受过开颅手术的患者 (OR: 2.71; 95% CI: 1.32-5.57; P =0.007) 和脑肿瘤体积较大的患者 (OR: 1.01; 95% CI: 1.00)对红细胞输注的需求也更大-1.02；P =0.009）。计划开颅部位数量与红细胞输注之间的关系无统计学意义（OR：2.11；95% CI：0.61-7.32；P =0.238）。使用这 4 个变量建立了 RBC 需求的预测模型。受试者工作特征曲线下面积为 0.79（95% CI：0.70-0.87；P<0.001) 表明预测 RBC 输血需求的可接受校准。

结论： 

使用基于现成的术前临床变量的预测模型，可以以可接受的准确度估计接受脑肿瘤手术的患者的红细胞需求。这种预测模型可以帮助优化个体患者和手术计划，并指导围手术期交叉匹配顺序。