7413 Preoperative Hematocrit and Transfusion Risk for Myomectomy Based on Surgical Route and Fibroid Burden

Abstract

<h3>Study Objective</h3> To determine the association between preoperative hematocrit and rate of transfusion for abdominal and laparoscopic myomectomy based on fibroid burden. <h3>Design</h3> Retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database. <h3>Setting</h3> NSQIP participating institutions. <h3>Patients or Participants</h3> 26,229 women who underwent a myomectomy from 2010 - 2020. <h3>Interventions</h3> Abdominal or laparoscopic myomectomy. <h3>Measurements and Main Results</h3> 2,345/26,229 (9%) patients received a blood transfusion intra or postoperatively. Compared with patients who did not require transfusion, those who required transfusion had lower median preoperative hematocrit levels (34.7 vs. 38.2, p<0.01). The preoperative hematocrit levels were inversely associated with the rate of transfusion both overall (53%, 42%, 32%, 20%, 11%, 6%, 5% 4% for preoperative hematocrit level categories <24, 24-27, 27-30, 30-33, 33-36, 36-39, 39-42, >42, respectively) and stratified by surgical approach and fibroid burden (abdominal/1-4 myomas/weight ≤250g: 63%, 30%, 34%, 19%, 9%, 6%, 5%, 3%; laparoscopic/1-4 myomas/weight ≤250g: 30%, 19%, 11%, 5%, 2%, 1%, 2%, 1%; abdominal/≥5 myomas/weight >250g: 61%, 68%, 52%, 35%, 22%, 15%, 12%, 8%; and laparoscopic/≥5 myomas/weight >250g: 25%, 52%, 17%, 7%, 6%, 4%, 3%; all p<0.01). In addition, compared with abdominal, laparoscopic myomectomy is associated with a lower risk of transfusion both overall (3% vs. 13%, odds ratio: 0.20, 95% confidence interval: 0.18 - 0.22, p<0.01) and stratified by fibroid burden (1-4 myomas/weight ≤250g: 2% vs 9%, p<0.01; and ≥5 myomas/weight >250g: 5% vs. 19%, p<0.01). <h3>Conclusion</h3> A laparoscopic approach and higher preoperative hematocrit were associated with a lower risk of transfusion for myomectomy. This study provides valuable data to optimize anemia prior to myomectomy to decrease the risk of transfusion, perform patient counseling regarding risk of transfusion for myomectomy, and select the optimal surgical route for myomectomy.