# Development and Validation of a Predictive Risk Score for Blood Transfusion in Patients Undergoing Curative‐Intent Surgery for Intrahepatic Cholangiocarcinoma

## TL;DR

This study creates a risk score to predict blood transfusion needs during surgery for intrahepatic cholangiocarcinoma, helping improve patient care and blood resource management.

## Contribution

A novel preoperative risk score and online calculator for predicting blood transfusion needs in intrahepatic cholangiocarcinoma surgery.

## Key findings

- 300 out of 1420 patients (21.1%) received intraoperative blood transfusion.
- Severe preoperative anemia, T2 category or higher, positive lymph nodes, and major resection were independent predictors of transfusion.
- Blood transfusion was significantly associated with worse postoperative outcomes.

## Abstract

Among patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.

Patients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.

Among 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (https://catalano-giovanni.shinyapps.io/TransfusionRisk).

Intraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.