Preoperative anemia and 30-day postoperative outcomes among women undergoing laparoscopic myomectomy

Abstract

More than half of women with symptomatic uterine fibroids experience heavy or prolonged menstrual bleeding. This contributes to chronic anemia among reproductive aged women. Although hysterectomy provides definitive surgical treatment, laparoscopic myomectomy is considered standard of care for the surgical management of symptomatic fibroids for women desiring uterine-sparing treatment. Preoperative anemia has been associated with increased risk of postoperative morbidity and mortality in gynecologic surgery. Current research on preoperative anemia in the benign gynecologic literature has primarily focused on hysterectomy, and little has been published regarding the risk profile for patients desiring myomectomy. The purpose of this study was to determine if preoperative anemia was associated with increased risk for 30-day postoperative morbidity or mortality following laparoscopic myomectomy. The aim was to provide clinical insight for gynecologic surgeons weighing the decision of whether to proceed with laparoscopic myomectomy for an anemic patient versus delaying surgery to focus on medical management and optimization. This retrospective population-based cohort study evaluated adult women who underwent laparoscopic myomectomy from 2014-2019. Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The exposure of interest was preoperative anemia, defined at hematocrit value less than 36% documented within 14-days prior to surgery. The primary outcome of interest was the occurrence of any minor or major postoperative complication as characterized by the standardized Clavien-Dindo classification utilizing bivariate and multivariable analysis. A total of 2097 cases were included for analysis; 26.66% of these women were anemic with an average preoperative hematocrit of 32.59% (±3.19%). There was a significant difference in the distribution of race/ethnicity, with most anemic patients self-identifying as “Black” (50.09%, p-value <0.001). Anemic patients were more likely to receive perioperative blood transfusion (4.29% versus 1.56%, p-value <0.01), had higher readmission rates (2.98% versus 1.16%, p-value 0.01), and were more likely to have “any” minor complication (7.16% versus 3.84%, p-value <0.01). After multivariate analysis adjusted for potential confounders, anemic patients had increased risk of experiencing a minor postoperative complication following laparoscopic myomectomy, with adjusted odds ratio of 1.71 (95% CI 1.10-2.66, p-value 0.02). However, there was no significant risk of any major postoperative complications. Preoperative anemia was common among women undergoing laparoscopic myomectomy. Anemia was not associated with increased risk for major postoperative complications within 30-days for this specific patient population.