Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty
Abstract Background The need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in p...
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doaj-426b5b3e0ba942e692eb7259841890fe2020-11-25T02:57:41ZengBMCBMC Musculoskeletal Disorders1471-24742020-05-012111910.1186/s12891-020-03328-9Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplastyChuan Hu0Yuan-he Wang1Rui Shen2Chuan Liu3Kang Sun4Lin Ye5Jian-jun Ye6Xu Yang7Shao-qi Tian8Teng-bo Yu9Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Medical Oncology, The First Hospital of China Medical UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityWenzhou Medical UniversityWenzhou Medical UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Orthopaedic Surgery, The Affiliated Hospital of Qingdao UniversityAbstract Background The need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in patients following TKA and develop a nomogram. Methods The nomogram was developed based on a training set of 5402 patients who underwent TKA at the Affiliated Hospital of Qingdao University between September 2013 and November 2018. The independent predictors of transfusion were identified by univariate, LASSO, and binary logistic regression analyses. Then, a nomogram was established based on these independent predictors. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. The results were validated using an independent set of 1116 patients who underwent TKA between December 2018 and September 2019. In addition, we also carried out subgroup analyses in the training and testing sets based on the independent predictors. Results Five independent predictors were identified by multivariate analysis and were used to establish the nomogram. The AUCs of the nomogram were 0.884 (95% CI: 0.865–0.903) and 0.839 (95% CI, 0.773–0.905) in the training and testing sets, respectively. In both the training and testing sets, the calibration curve indicated that the prediction by the nomogram was highly consistent with the actual observation, and the DCA indicated that the nomogram had a favorable level of clinical usefulness. In addition, the AUC of the nomogram was significantly higher than the AUC of any independent predictor for predicting transfusion risk following TKA, and the subgroup analysis showed good performance in 20 subgroups. Conclusion Lower preoperative Hb levels, simultaneous bilateral TKA, lower BMI, older age, and coronary heart disease were identified as independent predictors of postoperative transfusion in patients following TKA. A nomogram incorporating the above five predictors could accurately predict the transfusion risk.http://link.springer.com/article/10.1186/s12891-020-03328-9TransfusionRisk factorsTotal knee arthroplastyPreoperative nomogramValidationSubgroup analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chuan Hu Yuan-he Wang Rui Shen Chuan Liu Kang Sun Lin Ye Jian-jun Ye Xu Yang Shao-qi Tian Teng-bo Yu |
spellingShingle |
Chuan Hu Yuan-he Wang Rui Shen Chuan Liu Kang Sun Lin Ye Jian-jun Ye Xu Yang Shao-qi Tian Teng-bo Yu Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty BMC Musculoskeletal Disorders Transfusion Risk factors Total knee arthroplasty Preoperative nomogram Validation Subgroup analysis |
author_facet |
Chuan Hu Yuan-he Wang Rui Shen Chuan Liu Kang Sun Lin Ye Jian-jun Ye Xu Yang Shao-qi Tian Teng-bo Yu |
author_sort |
Chuan Hu |
title |
Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
title_short |
Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
title_full |
Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
title_fullStr |
Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
title_full_unstemmed |
Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
title_sort |
development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty |
publisher |
BMC |
series |
BMC Musculoskeletal Disorders |
issn |
1471-2474 |
publishDate |
2020-05-01 |
description |
Abstract Background The need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in patients following TKA and develop a nomogram. Methods The nomogram was developed based on a training set of 5402 patients who underwent TKA at the Affiliated Hospital of Qingdao University between September 2013 and November 2018. The independent predictors of transfusion were identified by univariate, LASSO, and binary logistic regression analyses. Then, a nomogram was established based on these independent predictors. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. The results were validated using an independent set of 1116 patients who underwent TKA between December 2018 and September 2019. In addition, we also carried out subgroup analyses in the training and testing sets based on the independent predictors. Results Five independent predictors were identified by multivariate analysis and were used to establish the nomogram. The AUCs of the nomogram were 0.884 (95% CI: 0.865–0.903) and 0.839 (95% CI, 0.773–0.905) in the training and testing sets, respectively. In both the training and testing sets, the calibration curve indicated that the prediction by the nomogram was highly consistent with the actual observation, and the DCA indicated that the nomogram had a favorable level of clinical usefulness. In addition, the AUC of the nomogram was significantly higher than the AUC of any independent predictor for predicting transfusion risk following TKA, and the subgroup analysis showed good performance in 20 subgroups. Conclusion Lower preoperative Hb levels, simultaneous bilateral TKA, lower BMI, older age, and coronary heart disease were identified as independent predictors of postoperative transfusion in patients following TKA. A nomogram incorporating the above five predictors could accurately predict the transfusion risk. |
topic |
Transfusion Risk factors Total knee arthroplasty Preoperative nomogram Validation Subgroup analysis |
url |
http://link.springer.com/article/10.1186/s12891-020-03328-9 |
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