Impact of an intraoperative “Blood Conservation Bundle” on perioperative transfusion rates during myomectomy

Abstract

Objectives Myomectomy is a common gynecologic procedure associated with high rates of blood loss and subsequent blood transfusion in reproductive-aged women. An intraoperative Blood Conservation Bundle (BCB) was developed as a standardized approach to decreasing blood loss during myomectomy. This study aimed to introduce the care bundle into clinical practice and assess its impact on various surgical outcomes. Methods We conducted a prospective cohort study assessing perioperative transfusion rates and intraoperative blood loss following open, robotic and laparoscopic myomectomy over a 12-month period following introduction of the BCB. Data were compared to a retrospective control group from a 24-month period prior to bundle introduction. The BCB is a physical checklist attached to the patient chart consisting of evidence-based medical and surgical interventions aimed at decreasing intraoperative blood loss. Results In the 24 months prior to introduction of the BCB, 134 myomectomies were performed and during the study period, 52 were performed. Perioperative transfusion rate was 15.7% pre- and 7.7% post-introduction of the BCB. Mean estimated blood loss was significantly lower post-intervention (491 ± 440 mL vs. 350 ± 255 mL, p<0.05). There was also a significantly lower mean delta hemoglobin (pre-operative hemoglobin– post-operative hemoglobin/pre-operative hemoglobin x100) post-intervention (22 ± 10.1% vs. 18 ± 8.6%, p<0.05). There was no difference in perioperative complications or readmissions. Conclusions Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of a Blood Conservation Bundle was associated with a reduction in intraoperative blood loss and transfusion rates during myomectomy at our institution. Myomectomy is a common gynecologic procedure associated with high rates of blood loss and subsequent blood transfusion in reproductive-aged women. An intraoperative Blood Conservation Bundle (BCB) was developed as a standardized approach to decreasing blood loss during myomectomy. This study aimed to introduce the care bundle into clinical practice and assess its impact on various surgical outcomes. We conducted a prospective cohort study assessing perioperative transfusion rates and intraoperative blood loss following open, robotic and laparoscopic myomectomy over a 12-month period following introduction of the BCB. Data were compared to a retrospective control group from a 24-month period prior to bundle introduction. The BCB is a physical checklist attached to the patient chart consisting of evidence-based medical and surgical interventions aimed at decreasing intraoperative blood loss. In the 24 months prior to introduction of the BCB, 134 myomectomies were performed and during the study period, 52 were performed. Perioperative transfusion rate was 15.7% pre- and 7.7% post-introduction of the BCB. Mean estimated blood loss was significantly lower post-intervention (491 ± 440 mL vs. 350 ± 255 mL, p<0.05). There was also a significantly lower mean delta hemoglobin (pre-operative hemoglobin– post-operative hemoglobin/pre-operative hemoglobin x100) post-intervention (22 ± 10.1% vs. 18 ± 8.6%, p<0.05). There was no difference in perioperative complications or readmissions. Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of a Blood Conservation Bundle was associated with a reduction in intraoperative blood loss and transfusion rates during myomectomy at our institution.