Evidence map›Paper›PMID 27696209›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2016

Impact of Delta Hemoglobin on Provider Transfusion Practices and Post-operative Morbidity Among Patients Undergoing Liver and Pancreatic Surgery.

Gaya Spolverato, Fabio Bagante, Matthew Weiss, Jin He, Christopher L Wolfgang, Fabian Johnston, Martin A Makary, Will Yang, Steven M Frank, Timothy M Pawlik

Registry-linked trialAbstract read
PubMed Publisher
In one paragraph

Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03885570 (Establishment of AI Prediction Model of Blood Transfusion Management in Patients With Mitral Valve Replacement), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03885570 unknown statusnot on this mapstarted 2019, after this paper: background citation

Establishment of AI Prediction Model of Blood Transfusion Management in Patients With Mitral Valve Replacement

TypeobservationalSponsorThe Third Xiangya Hospital of Central South UniversityRan2019 to 2021Enrolled2,000ConditionsMitral Valve Replacement, Transfusion Reaction, Blood Transfusion ComplicationArmsMitral valve replacement
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Gaya SpolveratoThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Fabio BaganteThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Matthew WeissThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jin HeThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Christopher L WolfgangThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Fabian JohnstonThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Martin A MakaryThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Will YangThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Steven M FrankThe Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Timothy M PawlikThe Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tim.pawlik@osumc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDelta hemoglobin (ΔHb) is defined as the difference between the preoperative Hb and the lowest post-operative Hb level. We sought to define the impact of ΔHb relative to nadir Hb levels on the likelihood of transfusion, as well as characterize the impact of ΔHb and nadir Hb on morbidity among a large cohort of patients undergoing complex hepatopancreatobiliary (HPB) surgery.

methodsPatients who underwent pancreatic or hepatic resection between January 1, 2009 and June 30, 2015 at Johns Hopkins Hospital were identified. Data on the perioperative ΔHb, nadir Hb, as well as blood utilization were obtained and analyzed. Multivariable logistic regression models were used to identify the factors associated with ΔHb and the impact of ΔHb on perioperative morbidity. A Bayesian model was used to evaluate the correlation of ΔHb and nadir Hb with the likelihood of transfusion, as well as the impact on morbidity.

resultsA total of 4363 patients who underwent hepatobiliary (n = 2200, 50.4 %) or pancreatic (n = 2163, 49.6 %) surgery were identified. More than one quarter of patients received at least one unit of packed red blood cells (PRBC) (n = 1187, 27.2 %). The median nadir Hb was 9.2 (IQR 7.9-10.5) g/dL resulting in an average ΔHb of 3.4 mg/dL (IQR 2.2-4.7) corresponding to 26.3 %. Both ΔHb and nadir Hb strongly influenced provider behavior with regards to use of transfusion. Among patients with the same nadir Hb, ΔHb was strongly associated with use of transfusion; among patients who had a nadir Hb ≤6 g/dL, the use of transfusion was only 17.9 % when the ΔHb = 10 % versus 49.1 and 80.9 % when the ΔHb was 30 or 50 %, respectively. Perioperative complications occurred in 584 patients (13.4 %) and were more common among patients with a higher value of ΔHb, as well as patients who received PRBC (both P < 0.001).

conclusionsThe combination of the Hb trigger with ΔHb was associated with transfusion practices among providers. Larger ΔHb values, as well as receipt of transfusion, were strongly associated with risk of perioperative complication following HPB surgery.

Indexed as

Practice Patterns, Physicians'AgedBayes TheoremCohort StudiesErythrocyte TransfusionFemaleHemoglobinsHepatectomyHumansMaleMiddle AgedPancreatectomyPostoperative PeriodPreoperative PeriodHemoglobinsDeltaHemoglobinHepatopancreatobiliaryOutcomesSurgery

Identifiers

PMID27696209

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.