Risk Factors Associated with Blood Transfusion in Laparoscopic Hysterectomy

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<h3>Study Objective</h3> To identify risk factors associated with perioperative blood transfusion in patients undergoing laparoscopic hysterectomy for any reason. <h3>Design</h3> Retrospective case-control study conducted between 01/01/2001 and 09/01/2019. <h3>Setting</h3> Large tertiary care center and its associated community referral hospital. <h3>Patients or Participants</h3> All patients who underwent laparoscopic hysterectomy for benign and malignant indications were included. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Medical records were reviewed using a centralized clinical data registry. Cases were defined as patients who received a perioperative red blood cell transfusion (72 hours before or after surgery). Differences between groups were analyzed using an independent samples t-test for means, Wilcoxon rank sum test for medians, and chi-square for categorical variables. Among the 8,321 patients who underwent laparoscopic hysterectomy, 61 (0.73%) had a perioperative transfusion. Age and smoking status were similar between groups; however, cases were more likely to be African-American, Asian, have a body mass index greater than 30 and be publicly insured or without insurance (p<0.05). Other variables associated with increased risk for transfusion included a diagnosis of abnormal uterine bleeding, coronary artery disease, history of dialysis or stage IV kidney disease, congestive heart failure or cerebrovascular disease, or active use of a blood thinner (P <0.05). Laparoscopic-assisted vaginal hysterectomy as a mode of surgery was also associated with transfusion (P<0.05). Of those who received a transfusion, 23 (37.1%) were performed intraoperatively (7 for preoperative anemia, 13 for large intraoperative blood loss, 2 for vascular injury and 1 for unknown reasons). Conversion to open laparotomy occurred in 27 cases, of which 5 underwent transfusion. <h3>Conclusion</h3> Our findings identify a subset of patients who are at higher risk of blood loss prior to laparoscopic hysterectomy and thus may benefit from a specific pre-operative transfusion preparedness strategy.