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Original article
Preoperative Blood Ordering in Elective Colon Surgery: Requirement or Routine?
Solicitud de sangre preoperatoria en cirugía programada de colon: ¿necesidad o rutina?
Francesc Feliua,
Corresponding author
ffvillaro@hotmail.com

Corresponding author.
, Juan C. Ruedaa, Laia Ramirob, Montserrat Olonac, Jorge Escudera, Fernando Grisa, Andrea Jiméneza, Enric Duquea, Vicente Vicentea
a Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Joan XXIII, Tarragona, Spain
b Banco de Sangre y Tejidos, Hospital Universitari Joan XXIII, Tarragona, Spain
c Unidad de Medicina Preventiva y Epidemiología, Hospital Universitari Joan XXIII, Tarragona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The routine ordering of cross-matched blood for elective colon surgery is a widely established procedure&#46; However&#44; there are very few surgical procedures which entail a high risk of perioperative haemorrhage and thus require blood transfusion&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Therefore the routine preparation of cross-matched blood is an inefficient use of resources and places a burden &#40;in terms of time and cost&#41; on hospital blood bank personnel&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Furthermore the association between perioperative blood transfusion and a higher morbimortality rate is widely accepted&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients need to be optimally prepared preoperatively and a series of intraoperative measures are implemented by anaesthetists and surgeons to avoid perioperative blood transfusion and minimise its adverse affects in elective surgery of the colon&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6&#44;10&#44;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Different factors need to be defined that could be indicative of the need for perioperative transfusion&#44; and protocols should be established for preoperative blood ordering which are relevant to each surgical procedure and serve as guidelines for more &#8220;rational&#8221; and efficient use of blood transfusion&#46; These programmes attempt to link the number of cross-matched blood units with the real number of blood units transfused&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We present a retrospective study of 457 consecutive cases of patients who underwent elective colon surgery in order to determine whether cross-matched blood ordering meets the real requirements for perioperative transfusion and to identify predictive factors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective&#44; observational&#44; epidemiological study including 457 patients treated consecutively by elective colon surgery&#44; during the period from January 2007 to September 2012&#46; Pretransfusion tests were requested for all the patients for the preparation of two units of preoperative cross-matched packed red blood cells &#40;914 units in total&#41;&#46; The patients were divided into two groups depending on whether or not they had received a transfusion of&#44; at least&#44; one unit of packed red cells during surgery and in the first 24<span class="elsevierStyleHsp" style=""></span>h following surgery&#46; The study variables were divided into three groups&#58; the first included the gender and age&#44; preoperative diagnosis &#40;classified as benign or malignant disease&#41;&#44; and the anatomical location in the colon &#40;right colon&#44; left colon and entire colon&#41;&#59; a second group comprising the preoperative variables and comorbidities of the patient&#44; such as previous abdominal surgery&#44; preoperative haemoglobin count &#40;Hb&#41; of less than or exceeding 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; arterial hypertension &#40;HTA&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; heart disease &#40;CARD&#41;&#44; chronic renal failure &#40;CRF&#41;&#44; chronic obstructive pulmonary disease &#40;COPD&#41; and administration of corticosteroids &#40;CORT&#41;&#44; oral anticoagulants &#40;OAC&#41; and anti-platelet agents &#40;APA&#41;&#59; and finally a third group including operative variables including operation time exceeding or less than 120<span class="elsevierStyleHsp" style=""></span>min&#44; and the surgical technique used&#44; summarised in terms of resection and primary anastomosis techniques &#40;R&#43;A&#41;&#44; and other techniques&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following transfusion rates were calculated &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; cross-match-to-transfusion ratio compatibility tests &#40;C&#58;T ratio&#41;&#44; transfusion probability &#40;&#37;<span class="elsevierStyleItalic">T</span>&#41; and transfusion rate &#40;Ti&#41;&#46; The descriptive analysis was undertaken using means and standard deviation for the quantitative variables&#44; and absolute and relative frequencies &#40;percentages&#41; for the categorical variables&#46; Univariable statistical analysis comparing transfusion&#47;non-transfusion groups was performed using the Student&#39;s <span class="elsevierStyleItalic">t</span> test for continuous variables and the chi-square test for categorical variables&#46; Multiple logistic regression analysis&#44; step-by-step maximum likelihood method&#44; was used to assess the factors associated with receiving a blood transfusion after adjusting possible confounding effects&#46; The dependent variable was blood transfusion &#40;yes&#47;no&#41;&#44; whereas the independent variables included were the significant variables in the univariable analysis or with biological plausibility&#46; The results are presented in <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; and 95&#37; confidence interval &#40;95&#37; CI&#41;&#46; The receiver operating characteristic curve &#40;ROC curve&#41; was calculated to obtain the sensitivity&#47;specificity for each probability value&#44; selecting the best overall value as the cut-off point&#46; The value of the area under the curve and its 95&#37; confidence interval are presented &#40;95&#37; CI&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The accepted level of statistical significance was <span class="elsevierStyleItalic">P</span>&#8804;&#46;05&#46; The data were analysed using the statistical programme SPSS&#44; version 15&#46;0&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 457 patients included in the study&#44; 239 were males &#40;52&#46;3&#37;&#41; and 218 females &#40;47&#46;7&#37;&#41;&#44; the average age of the patient was 69&#46;6&#177;12&#46;4 &#40;range 21&#8211;94&#41;&#46; As per the diagnosis&#44; 78 patients had benign disease &#40;17&#46;1&#37;&#41; and 379 cases had malignant disease &#40;82&#46;9&#37;&#41;&#46; The benign diagnoses were&#58; adenomas &#40;33&#41;&#44; ulcerative colitis &#40;3&#41;&#44; Crohn&#39;s disease &#40;1&#41;&#44; diverticular disease &#40;37&#41;&#44; lipomas of the colon &#40;2&#41; and one patient had sigmoid volvulus&#46; The diseases classified as malignant were 374 cases of adenocarcinoma&#44; one neuroendocrine carcinoma&#44; one Gardner&#39;s syndrome&#44; one Lynch syndrome and two cases of high grade appendicular mucinous tumours&#46; The anatomical location was&#58; right colon &#40;191 cases&#58; 41&#46;8&#37;&#41;&#44; left colon &#40;242 cases&#58; 53&#46;0&#37;&#41;&#44; and entire colon &#40;24 cases&#58; 5&#46;3&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In terms of preoperative data and prior clinical history&#58; 43 patients &#40;9&#46;4&#37;&#41; were identified with Hb levels lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; 165 patients &#40;36&#46;1&#37;&#41; had a history of previous abdominal surgery&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Comorbidities recorded were&#58; HTA &#40;202 cases&#58; 44&#46;2&#37;&#41;&#44; DM &#40;86 cases&#58; 18&#46;8&#37;&#41;&#44; CARD &#40;74 cases&#58; 16&#46;2&#37;&#41;&#44; CRF &#40;13 cases&#58; 2&#46;8&#37;&#41; and COPD &#40;49 cases&#58; 10&#46;7&#37;&#41;&#46; Patients on oral CORT medication &#40;6 cases&#58; 1&#46;3&#37;&#41;&#44; OAC medication &#40;29 cases&#58; 6&#46;3&#37;&#41; and APA medication &#40;43 cases&#58; 9&#46;4&#37;&#41; were also identified&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Two groups of surgical procedures were defined&#58; R&#43;A &#40;423 patients&#58; 92&#46;5&#37;&#41; and other procedures &#40;34 patients&#58; 7&#46;5&#37;&#41;&#46; Two groups of patients were established in terms of duration of surgery&#58; those with a surgical time of less than 120<span class="elsevierStyleHsp" style=""></span>min &#40;401 patients&#58; 87&#46;7&#37;&#41;&#44; and those with a longer duration of surgery &#40;56 patients&#58; 12&#46;3&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">74 patients received a transfusion &#40;16&#46;2&#37;&#41;&#44; with a total of 171 units &#40;an average of 2&#46;3 units per patient&#41;&#46; The total preparation time by blood bank personnel was 286<span class="elsevierStyleHsp" style=""></span>h&#44; with an average 38<span class="elsevierStyleHsp" style=""></span>min per patient&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The overall cost&#44; taking into account only the pretransfusion compatibility tests&#44; came to 18&#44;654&#46;82 &#8364;&#44; with an average of 40&#46;82 &#8364; per patient&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The transfusion rates calculated were&#58; C&#58;T ratio&#61;5&#46;34&#59; &#37;<span class="elsevierStyleItalic">T</span>&#61;16&#46;2&#37; and Ti&#61;0&#46;18&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The results of the univariable analysis are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There are significant differences with regard to age and the group which had received a transfusion being older &#40;73&#46;3&#177;11&#46;2 compared to 68&#46;8&#177;12&#46;5 years of age&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to preoperative diagnosis&#44; there was no significant difference in the comparison between benign and malignant diseases&#46; In the distribution of diseases according to their anatomical location in the colon&#44; we can see that the group which behaved differently to the other two was the left colon group&#44; i&#46;e&#46;&#44; a greater risk of requiring a blood transfusion was found in the right colon group compared to the left colon group &#40;19&#46;9&#37; compared to 12&#46;0&#37; respectively&#41;&#44; and in the entire colon group compared to the left colon group &#40;29&#46;2&#37; compared to 12&#46;0&#37; respectively&#41;&#46; The differences in the right colon and the entire colon compared to the left colon are statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">There are also significant differences in terms of preoperative Hb level&#44; in that 41 patients &#40;95&#46;3&#37;&#41; with an Hb lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl were transfused compared to 33 patients &#40;8&#37;&#41; with an Hb above 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46; There are no significant differences with regard to a history of previous surgery &#40;17&#46;6&#37; compared to 15&#46;4&#37; transfused patients&#44; respectively&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">When studying the proportion of transfused patients according to comorbidities&#44; it can be observed that patients with DM &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#44; CARD &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#44; CRF &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;043&#41;&#44; COPD &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41; or receiving OAC treatment &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41; received more transfusions than those who did not have the illnesses diseases or who did not need the medication &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The surgical technique used did not show results of statistical significance in the analysis of both groups&#46; On the contrary&#44; the patients with a surgery time exceeding 120<span class="elsevierStyleHsp" style=""></span>min represented 39&#46;3&#37; cases of transfusion&#44; compared to 13&#46;0&#37; of cases in the group of patients with a surgery time of less than 120<span class="elsevierStyleHsp" style=""></span>min&#59; the difference is statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The results of multiple logistic regression analysis are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; the significant variables were&#58; Hb levels&#60;10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; a history of COPD&#44; receiving OAC treatment and surgery of a duration exceeding 120<span class="elsevierStyleHsp" style=""></span>min&#46; The prediction equation of the probability of receiving a transfusion from the values of these factors is included in the table&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> presents the ROC sensitivity curve for predicted probability&#46; Therefore the cut-off point with the best overall value is predicted probability of 0&#46;2&#44; which presents 77&#37; sensitivity and 90&#46;6&#37; specificity&#46; The area under the curve was 0&#46;88 &#40;95&#37; CI&#58; 0&#46;83&#8211;0&#46;94&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">A subanalysis was made to evaluate which factors were associated with transfusion in patients with a HB above 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; In this group of 414 patients&#44; only a total of 33 &#40;8&#37;&#41; patients were transfused with a total of 96 units&#44; which represent 56&#46;1&#37; of the total units transfused in the general group&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The transfusion rates calculated in this group of patients with preoperative Hb above 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl were&#58; C&#58;T ratio&#61;8&#46;62&#59; &#37;<span class="elsevierStyleItalic">T</span>&#61;8&#37; and Ti&#61;0&#46;11&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The transfusion rates of the two groups of patients&#44; total group and group with preoperative Hb&#62;10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The variables significantly associated with having received a transfusion in this subgroup were&#58; having heart disease &#40;15&#46;5&#37; compared to 6&#46;7&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;033&#41;&#59; receiving oral anticoagulant therapy &#40;25&#37; compared to 7&#46;2&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;015&#41;&#59; and a surgery time exceeding 120<span class="elsevierStyleHsp" style=""></span>min &#40;32&#37; compared to 4&#46;3&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46; A history of COPD shows an association close to statistical significance &#40;16&#46;7&#37; compared to 7&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;055&#41;&#46; The results of multiple logistic regression analysis show that the independent variables significantly associated with having received a transfusion are&#58; duration of surgery exceeding 120<span class="elsevierStyleHsp" style=""></span>min &#40;OR&#61;11&#46;3&#59; 95&#37; CI&#58; 4&#46;7&#8211;25&#46;8&#41;&#44; having a history of COPD &#40;OR&#58; 3&#46;9&#59; 95&#37; CI&#58; 1&#46;3&#8211;12&#46;3&#41; and receiving treatment with OAC &#40;OR&#58; 6&#46;3&#59; 95&#37; CI&#58; 1&#46;9&#8211;18&#46;0&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the ROC sensitivity curve for predicted probability according to the equation obtained&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0130" class="elsevierStylePara elsevierViewall">Thus&#44; the cut-off point of best overall value has a predicted probability of 0&#46;13&#44; presenting 55&#37; sensitivity and 87&#46;1&#37; specificity&#46; The area under the curve was 0&#46;74 &#40;95&#37; CI&#58; 0&#46;64&#8211;0&#46;85&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">Requesting preoperative cross-matched blood is routine practice in elective surgery&#44; even for surgical procedures with minimal perioperative blood &#37;<span class="elsevierStyleItalic">T</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;11&#44;13&#44;14</span></a> This preparation of cross-matched packed red blood cells goes beyond real needs&#46; The first data published in this regard are the work of Friedman in 1973&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In this study the ratio of cross-matched blood to transfused blood &#40;C&#58;T ratio&#41;&#44; &#37;<span class="elsevierStyleItalic">T</span> and Ti were used as indicators to demonstrate that requesting cross-matched blood preoperatively was unnecessary&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Kozarzewska et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> state that the values which justify ordering cross-matched blood preoperatively are a C&#58;T ratio&#8804;3&#44; a &#37;<span class="elsevierStyleItalic">T</span>&#8805;30&#37; and Ti&#8805;0&#46;5&#46; However&#44; their results were a C&#58;T ratio&#61;9&#44; a &#37;<span class="elsevierStyleItalic">T</span>&#61;10&#46;9 and a Ti&#61;0&#46;27&#44; very far from real needs&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Other studies have been published in recent years which attempt to provide information on the disparity which exists between preoperatively cross-matched blood units and those which are eventually transfused for each surgical procedure&#46; This routine preparation imposes a real burden on blood banks&#44; both in terms of time and financial resources&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;11&#44;13&#44;16&#8211;18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Singh and Singh<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> encountered a &#37;<span class="elsevierStyleItalic">T</span>&#61;14&#37; in patients scheduled for colorectal surgery&#44; with a C&#58;T ratio&#61;3&#46;7 and a Ti&#61;0&#46;26&#46; Similar data were obtained by Palmer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> finding a transfusion percentage of 16&#37;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The observational retrospective study we present all the identified 457 consecutive patients who underwent elective colonic surgery&#44; two units of cross-matched blood having been routinely requested for each preoperatively &#40;914 units in total&#41;&#44; of which only 171 units were transfused in 74 patients &#40;16&#46;2&#37;&#41;&#46; This study attempts to identify the factors associated with perioperative blood transfusion which justify preoperatively requesting and preparing cross-matched packed red blood cells&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Rather than making an analysis by diagnosis or surgical procedure&#44; the diagnoses were divided into two groups&#44; benign disease and malignant disease &#40;83&#37; adenocarcinoma&#41;&#44; and surgical procedures into resection and anastomosis techniques and other surgery&#46; Similarly&#44; the only preoperative analytical datum in the study were the plasma Hb count&#44; but classifying the patients as to whether the count was higher or lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; rather than using mean values for each group as in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In this way the results were simplified&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In this regard&#44; the preoperative Hb variable was the factor with the greatest strength of association with the probability of having received a transfusion &#40;OR&#58; 309&#46;8&#59; 95&#37; CI&#58; 52&#46;7&#8211;985&#46;2&#41;&#44; as 95&#46;3&#37; of patients with an Hb lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl were transfused compared to 8&#37; of patients with an Hb above 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; Since practically all of the patients with an Hb lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl received a transfusion&#44; this in itself would be an indication for reserving blood&#44; as long as it was not possible to resolve this prior to surgery by the appropriate treatment of the patient&#46; Other factors independently associated with receiving a transfusion were a surgery time exceeding 120<span class="elsevierStyleHsp" style=""></span>min&#44; a history of COPD and receiving OAC therapy&#46; The probability predicted by the equation has significant predictive capacity&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We decided to study the subgroup of patients with an Hb above 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl to look for predictive factors for transfusion in these patients&#44; which are the same as we found in the total sample&#58; surgery time exceeding 120<span class="elsevierStyleHsp" style=""></span>min&#44; a history of COPD and receiving OAC therapy&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The need to evaluate predisposing factors for a blood transfusion in patients recommended for elective surgery was initially published by Ayantunde et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> in patients who were candidates for oesophagectomy due to cancer&#46; The study concluded that the predictive factors for a blood transfusion are age and the presence of comorbidities&#46; Other predictive factors were low preoperative Hb counts&#44; being female and type of surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;19&#44;20</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">There is some work which attempts to formulate guidelines in which the ratio between requesting cross-matched blood preoperatively and the blood eventually transfused &#40;C&#58;T ratio&#41; should not exceed 2&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;21</span></a> Indicators such as the Maximum Surgical Blood Ordering Schedule &#40;MSBOS&#41; and its subsequent amendment&#44; and Mead&#39;s criteria<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a> attempt to predict the preoperative risk of blood transfusion for each surgical procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;11&#44;18</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">There are two objectives&#58; not to overexploit the system&#39;s resources and to minimise the risks of transfusion&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Due to the immunomodulation induced by blood transfusion&#44; there is a greater risk of postoperative infection&#44; deep vein thrombosis&#44; and a higher rate of anastomotic dehiscence and neoplasic recurrence in oncological patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;30</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The authors are exposing the habit of excessive preoperative ordering of cross-matched blood beyond real needs&#44; which places a burden on the health system&#46; It is essential to rationalise cross-matched blood ordering and establish the number of blood units which should be ordered for each surgical procedure&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">Routine preoperative ordering of cross-matched blood is not justified in elective colon surgery and is an inefficient use of health resources&#46; Predictive factors for transfusion must be identified for selective ordering of cross-matched blood in line with these factors&#46; In our case&#44; the abovementioned high risk factors for transfusion are a history of COPD&#44; treatment with OAC and a predictable duration of surgery exceeding 120<span class="elsevierStyleHsp" style=""></span>min&#46; Patients with a preoperative plasma Hb count lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl should not undergo elective colon surgery unless their anaemia has been treated to increase their Hb count&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of Interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "identificador" => "xpalclavsec297733"
          "palabras" => array:3 [
            0 => "Preoperative surgical blood ordering"
            1 => "Transfusional indices"
            2 => "Perioperative transfusion"
          ]
        ]
      ]
      "es" => array:1 [
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec297732"
          "palabras" => array:3 [
            0 => "Solicitud de sangre preoperatoria"
            1 => "&#205;ndices transfusionales preoperatorios"
            2 => "Transfusi&#243;n peroperatoria"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Preoperative blood ordering is frequently used in elective colon surgery&#44; even for procedures that rarely require blood transfusion&#46; Most often this procedure is performed without proper analysis of the real needs&#46; The aim of this study was to evaluate the patients who receive transfusion and to determine their associated factors&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of all consecutive patients scheduled for elective colon surgery was carried out at 2007&#8211;2012&#46; Several clinico-pathological and surgical variables were analysed and predictive blood transfusion indices such as the cross-matched&#47;transfusion ratio &#40;C&#47;T ratio&#41;&#44; transfusion index and transfusion probability were calculated&#46; Patients were divided into 2 groups accordingly whether they have received perioperative surgical transfusion or not&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 457 surgery patients&#46; A total of 171 blood units&#44; in 74 patients were perioperatively transfused&#46; Overall cross-matched transfusion ratio was 5&#46;34&#44; the transfusion probability 162&#37;&#44; and the transfusion index 0&#46;18&#46; Variables that were significantly associated with receiving blood transfusion in a multivariable analysis were a preoperative haemoglobin level less than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;OR&#58; 309&#46;8&#59; 95&#37; CI&#58; 52&#46;7&#8211;985&#46;2&#41;&#44; chronic pulmonary obstructive disease &#40;OR&#58; 3&#46;7&#59; 95&#37; CI&#58; 1&#46;3&#8211;10&#46;7&#41;&#44; oral anticoagulant therapy &#40;OR&#58; 5&#46;7&#59; 95&#37; CI&#58; 1&#46;7&#8211;19&#46;4&#41; and surgical time over 120<span class="elsevierStyleHsp" style=""></span>min &#40;OR&#58; 10&#46;7&#59; 95&#37; CI&#58; 4&#46;7&#8211;24&#46;1&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Likelihood of receiving perioperative transfusion in elective colon surgery is very low&#46; Among their associated factors&#44; the haemoglobin level less than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl is the one with strongest association&#46; Those patients with such low preoperative haemoglobin level should not be scheduled for elective colon surgery until they received specific treatment&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La solicitud de sangre preoperatoria en cirug&#237;a programada de colon es una norma frecuente&#44; incluso en aquellos procedimientos con escasa probabilidad de transfusi&#243;n&#46; El objetivo de este estudio es evaluar la proporci&#243;n de pacientes que reciben transfusi&#243;n peroperatoria y determinar sus factores asociados&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes consecutivos en cirug&#237;a electiva de colon en el periodo 2007-2012&#46; Se analizan variables clinicopatol&#243;gicas&#44; quir&#250;rgicas y se calculan la ratio sangre &#171;en reserva&#187;&#47;sangre transfundida &#40;ratio<span class="elsevierStyleHsp" style=""></span>C&#47;T&#41;&#44; la probabilidad de transfusi&#243;n y el &#237;ndice transfusional&#46; Los pacientes se dividen en 2 grupos en funci&#243;n de haber recibido o no transfusi&#243;n peroperatoria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se contabilizan 457 pacientes&#44; transfundi&#233;ndose 171 unidades sangu&#237;neas en 74 pacientes&#44; siendo la probabilidad de transfusi&#243;n del 16&#44;2&#37;&#44; la ratio C&#47;T de 5&#44;34 y el &#237;ndice transfusional de 0&#44;18&#46; Las variables que se han asociado significativamente a recibir transfusi&#243;n sangu&#237;nea tras el an&#225;lisis multivariable son&#58; la cifra preoperatoria de hemoglobina inferior a 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;OR&#58; 309&#44;8&#59; IC 95&#37;&#58; 52&#44;7-985&#44;2&#41;&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;OR&#58; 3&#44;7&#59; IC 95&#37;&#58; 1&#44;3-10&#44;7&#41;&#44; anticoagulaci&#243;n oral &#40;OR&#58; 5&#44;7&#59; IC 95&#37;&#58; 1&#44;7-19&#44;4&#41; y tiempo quir&#250;rgico superior a 120<span class="elsevierStyleHsp" style=""></span>min &#40;OR&#58; 10&#44;7&#59; IC 95&#37;&#58; 4&#44;7-24&#44;1&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La probabilidad de necesidad de transfusi&#243;n en pacientes a los que se les realiza cirug&#237;a electiva de colon es baja&#46; Entre los factores asociados&#44; la cifra de hemoglobina preoperatoria inferior a 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl es el que presenta una mayor fuerza de asociaci&#243;n&#46; Los pacientes con dichas cifras de hemoglobina preoperatoria no deber&#237;an ser intervenidos en cirug&#237;a electiva de colon hasta haber recibido tratamiento apropiado&#46;</p>"
      ]
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Feliu F&#44; Rueda JC&#44; Ramiro L&#44; Olona M&#44; Escuder J&#44; Gris F&#44; et al&#46; Solicitud de sangre preoperatoria en cirug&#237;a programada de colon&#58; &#191;necesidad o rutina&#63; Cir Esp&#46; 2014&#59;92&#58;44&#8211;51&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Proportion of transfusions according to comorbidity&#46; OAC&#58; oral anticoagulants&#59; APA&#58; anti-platelet agents&#59; CARD&#58; heart disease&#59; CORT&#58; corticosteroids&#59; DM&#58; diabetes mellitus&#59; COPD&#58; chronic obstructive pulmonary disease&#59; AHT&#58; arterial hypertension&#59; CRF&#58; chronic renal failure&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">&#42;There are statistically significant differences between patients with the disease and patients without the disease &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ratio&#8201;C&#47;T&#61;no&#46;&#8201;of&#8201;cross-matched&#8201;unitsno&#46;&#8201;of&#8201;transfused&#8201;units&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8804;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transfusion&#8201;probability&#8201;&#40;&#37;T&#41;&#61;no&#46;&#8201;of&#8201;transfunded&#8201;patients&#215;100no&#46;&#8201;of&#8201;patients&#8201;with&#8201;compatibility&#8201;tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#62;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Transfusion&#8201;rate&#8201;&#40;TI&#41;&#61;no&#46;&#8201;of&#8201;transfused&#8201;unitsno&#46;&#8201;of&#8201;cross-matched&#8201;units&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">457&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">16&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">83&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Males&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">239&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">52&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Benign D&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Preop Hb</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">414&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">381&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previous surgery</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;597&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">292&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">247&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AHT yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AHT no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CARD yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CARD no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CRF yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OAC yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>APA yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>APA no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">90&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">346&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Transfusion&#8201;probability&#61;e&#8722;3&#46;36&#177;5&#46;7&#215;preop&#8201;Hb&#8201;10&#177;2&#46;38&#215;&#8201;time&#8201;120&#8201;min&#177;1&#46;75&#215;OAC&#177;1&#46;29&#215;COPD1&#43;e&#8722;3&#46;36&#43;5&#46;7&#215;preop&#8201;Hb&#8201;10&#43;2&#46;38&#215;time&#8201;120&#8201;min&#43;1&#46;75&#215;OAC&#43;1&#46;29&#215;COPD&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">OAC&#44; oral anticoagulants&#59; COPD&#44; chronic obstructive pulmonary disease&#59; Hb&#44; haemoglobin&#59; CI&#44; confidence interval&#59; OR&#44; odds ratio&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;3&#8211;10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&#8211;19&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;120&#47;&#62;120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8&#8211;24&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preoperative Hb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;10&#47;&#62;10<span class="elsevierStyleHsp" style=""></span>g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">309&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;7&#8211;985&#46;2&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Tr&#44; transfusion rate&#58; recommended value&#8805;0&#46;5&#59; C&#58;T ratio&#44; ratio cross-matched units to transfused units&#58; recommended value&#8804;2&#46;5&#59; &#37;<span class="elsevierStyleItalic">T</span>&#44; transfusion probability&#58; recommended value&#62;50&#37;&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Cross-matched units&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Transfused patients&nbsp;\t\t\t\t\t\t\n
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ISSN: 21735077
Original language: English
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2017 August 15 2 17
2017 July 10 1 11
2017 June 17 4 21
2017 May 11 5 16
2017 April 9 12 21
2017 March 17 1 18
2017 February 16 2 18
2017 January 10 1 11
2016 December 15 9 24
2016 November 23 5 28
2016 October 57 11 68
2016 September 32 6 38
2016 August 53 15 68
2016 July 24 1 25
2016 June 22 4 26
2016 May 29 9 38
2016 April 15 6 21
2016 March 25 9 34
2016 February 16 6 22
2016 January 10 7 17
2015 December 20 3 23
2015 November 19 3 22
2015 October 22 5 27
2015 September 25 5 30
2015 August 13 6 19
2015 July 17 4 21
2015 June 13 1 14
2015 May 15 4 19
2015 April 13 9 22
2015 March 14 16 30
2015 February 17 1 18
2015 January 40 4 44
2014 December 47 9 56
2014 November 33 4 37
2014 October 26 5 31
2014 September 26 4 30
2014 August 18 4 22
2014 July 22 3 25
2014 June 13 2 15
2014 May 20 3 23
2014 April 16 6 22
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos