Development of a nomogram for predicting perioperative blood transfusions in major hepatobiliary and colorectal surgeries: a retrospective study
MyJA 3-1 67 PDF


How to Cite

Anverdeen, M. Z., Sayed Masri, S. N. N., Ramli, M. F., Tan, T. S., Mohamad Mahdi, S. N., & Md Nor, N. (2024). Development of a nomogram for predicting perioperative blood transfusions in major hepatobiliary and colorectal surgeries: a retrospective study. Malaysian Journal of Anaesthesiology, 3(1), 25–40.

Copyright notice

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2024 Mohamad Zahir Anverdeen, Syarifah Noor Nazihah Sayed Masri, Mohd Faizal Ramli, Tse Siang Tan, Siti Nidzwani Mohamad Mahdi, Nadia Md Nor


blood transfusions; hepatobiliary and colorectal surgery; nomogram; risk prediction tool


Background: Major hepatobiliary and colorectal surgeries are associated with a risk of blood transfusions. However, risk assessment tools for predicting blood transfusions have not been studied extensively among patients undergoing these types of surgeries. We evaluated the risk factors for perioperative blood transfusions in patients who underwent major hepatobiliary and colorectal surgeries and subsequently created a nomogram.

Methods: Medical records of patients who underwent elective major hepatobiliary and colorectal surgeries in a single university hospital in Malaysia from 2015 to 2020 were retrospectively reviewed. A nomogram to predict transfusions risk was developed, and its discriminatory ability was tested using the area under the receiver operating characteristic (ROC) curve.

Results: Data from 293 patients (61.1% male) with an average age of 59.7 years (± SD 14.51) were analysed. The prevalence of anaemia was 61.1%. A total of 127 patients (43.3%) received at least 1 unit of packed red cells transfusions. On multivariable analysis, gender (odds ratio [OR 1.646), preoperative haemoglobin of 8.0 g/dl or less (OR 0.777), Charlson Comorbidity Index score (OR 1.14) and procedure type (versus colonic surgery, major hepatectomy, OR 6.094; other pancreatomy, OR 1.487; Whipple’s procedure, OR 9.667; and anterior resection, OR 3.569) were associated with a significantly higher risk of transfusions. All 4 of these factors were included in the nomogram. The nomogram’s discrimination and calibration results showed an AUROC curve of 0.754.

Conclusion: The nomogram effectively predicted the need for blood transfusions in major colorectal and hepatobiliary surgeries in our patients.
MyJA 3-1 67 PDF


Bennett S, Baker L, Shorr R, Martel G, Fergusson D. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review protocol. Syst Rev. 2016;5:38.

Fong IW. Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges. Current Trends and Concerns in Infectious Diseases. 2020:191-215.

Stramer SL, Dodd RY. Transfusion-transmitted emerging infectious diseases: 30 years of challenges and progress. Transfusion. 2013;53(10 Pt 2):2375-2383.

Webster NR. Stranger danger-mortality after transfusions. Br J Anaesth. 2017;118(3):280-282.

Bian FC, Cheng XK, An YS. Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram. Journal of Orthopaedic Surgery and Research. 2021;16(1):406.

Guo Y, You L, Hu H, et al. A Predictive Nomogram for Red Blood Cell Transfusion in Pheochromocytoma Surgery: A Study on Improving the Preoperative Management of Pheochromocytoma. Front Endocrinol (Lausanne). 2021;12:647610.

Lee B-H, Lee K-S, Kim H-I, et al. Blood Transfusion, All-Cause Mortality and Hospitalization Period in COVID-19 Patients: Machine Learning Analysis of National Health Insurance Claims Data. Diagnostics. 2022;12(12):2970.

Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16(4):e173-180.

Hu C, Wang Y-h, Shen R, et al. Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty. BMC Musculoskeletal Disorders. 2020;21(1):315.

Kim Y, Bagante F, Gani F, et al. Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery. Br J Surg. 2016;103(9):1173-1183.

Yusop Mohd Faeiz Mtn, Syed Azim Sharifah Mai Sarah, Kamaruzaman Ameera Ashyila, Kugaan Arvend, Osman Mohd Fairuz, Hatta Nur Raihan, Tengku Yazid Tengku Norita, Mokhtar Suryati, Omar Haniza, Amir Ahmad Suhaimi. Intraoperative Blood Loss and Blood Transfusion Requirement Among Liver Transplant Recipients.

A National Single Center Experience 2020. Asian Journal of Transfusion Science. 2021.

Tohme S, Varley PR, Landsittel DP, Chidi AP, Tsung A. Preoperative anemia and postoperative outcomes after hepatectomy. HPB (Oxford). 2016;18(3):255-261.

Bansal SS, Hodson J, Khalil K, et al. Distinct risk factors for early and late blood transfusion following pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int. 2018;17(4):349-357.

Guo K, Ma S. The Immune System in Transfusion-Related Acute Lung Injury Prevention and Therapy: Update and Perspective. Front Mol Biosci. 2021;8:639976.

Klein AA, Collier T, Yeates J, et al. The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery. Br J Anaesth. 2017;119(3):394-401.

Pulitanò C, Arru M, Bellio L, Rossini S, Ferla G, Aldrighetti L. A risk score for predicting perioperative blood transfusion in liver surgery. Br J Surg. 2007;94(7):860-865.

Roubinian NH, Murphy EL, Swain BE, Gardner MN, Liu V, Escobar GJ. Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity. BMC Health Serv Res. 2014;14:213.

Maempel JF, Wickramasinghe NR, Clement ND, Brenkel IJ, Walmsley PJ. The pre-operative levels of haemoglobin in the blood can be used to predict the risk of allogenic blood transfusion after total knee arthroplasty. Bone Joint J. 2016;98-b(4):490-497.

Sima CS, Jarnagin WR, Fong Y, et al. Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy. Ann Surg. 2009;250(6):914-921.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.

Lakomkin N, Goz V, Lajam CM, Iorio R, Bosco JA, 3rd. Higher Modified Charlson Index Scores Are Associated With Increased Incidence of Complications, Transfusion Events, and Length of Stay Following Revision Hip Arthroplasty. J Arthroplasty. 2017;32(4):1121-1124.

Safiri S, Kolahi A-A, Noori M, et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology. 2021;14(1):185.

Zwiep TM, Gilbert RWD, Moloo H, et al. Improving the treatment of pre-operative anemia in hepato-pancreato-biliary patients: a quality improvement initiative. Patient Safety in Surgery. 2020;14(1):18.

Clevenger B, Richards T. Pre-operative anaemia. Anaesthesia. 2015;70(s1):20-e28.

Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg. 2003;237(6):860-869; discussion 869-870.

Baker L, Park L, Gilbert R, et al. Intraoperative Red Blood Cell Transfusion Decision-making: A Systematic Review of Guidelines. Ann Surg. 2021;274(1):86-96.

Prochaska M, Salcedo J, Berry G, Meltzer D. Racial differences in red blood cell transfusion in hospitalized patients with anemia. Transfusion. 2022;62(8):1519-1526.

MyJA 3-1 67 PDF