Truchet, M. (Marvin) (2019) A predictive model for blood loss in the elderly undergoing cardiac surgery. thesis, Medicine.
Full text available on request.Abstract
OBJECTIVES The aim of this study was to determine significant preoperative predictors for postoperative blood loss in a population of patients of 70 years or older undergoing elective cardiac surgery, and to determine the predictive power of a model based upon these predictors. BACKGROUND Elderly patients undergoing cardiac surgery are at an increased risk for major bleeding. Risk stratification can aid in estimating risk for excessive postoperative blood loss. Accurate risk prediction of excessive postoperative blood loss could facilitate personalized medicine. METHODS This was a retrospective cohort study of 513 patients aged 70 years or older, undergoing cardiac surgery in a cardiac surgery centre in Nieuwegein, The Netherlands. Patients were assigned a bleeding score using the Universal Definition of Postoperative Bleeding (UDPB), and labelled as bleeders or non-bleeders. Univariate analysis was used to determine predictors for blood loss. Multivariate logistic regression was used to determine independent predictors for postoperative bleeding. An ROC-curve was then fitted to determine the predictive power of the model. RESULTS Among 513 included patients undergoing cardiac surgery, 405 patients were labelled as non-bleeders and 108 patients were labelled as bleeders. The final model included the EUROscore II (OR: 1,108, p = 0,020, 95%CI: 1,016-1,207), fibrinogen <3g/L in combination with haemoglobin <7,5mmol/L) (OR: 2,582, p = 0,023, 95%CI: 1,138-5,856) and CABG combined with valve surgery (OR: 2,259, p = 0,001, 95%CI: 1,366-3,735) as independent predictors for postoperative bleeding. The predictive power of this model was moderate (AUC: 0,67). CONCLUSIONS Using a combination of the EUROscore II, fibrinogen of less than 3g/dL, haemoglobin less than 7,5mmol/L, and CABG combined with valve surgery, we have developed a bleeding prediction score that is easy and quick to use for the prediction of bleeding among aged patients undergoing cardiac surgery.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Groen, prof. dr. G.J. |
| Supervisor name: | Begeleider: and Vlot, drs. E.A. and Noordzij, dr. P. G. and Sint Antoniusziekenhuis Nieuwegein, intensive care en anesth |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:59 |
| Last Modified: | 25 Jun 2020 10:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1908 |
Actions (login required)
 |
View Item |