Abstract
The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease. This study is a retrospective chart review including all the patients who underwent hysterectomy for benign disease between January 1st 2018 and December 31st 2019. Patients who received perioperative blood transfusion were identified and compared to those who did not. The following risk factors for blood transfusion were analyzed: route of hysterectomy, BMI, presence of adhesions, history of cesarean section, uterine weight. Descriptive statistics was used to analyze the data. A total of 517 patients were identified and included in the study. Forty-seven patients (9.09%) received a perioperative blood transfusion. The abdominal hysterectomy route (TAH) was a significant risk factor for receiving blood transfusion (p = 0.012). Other identified risk factors for blood transfusion included: Body mass index above 33.0 (p = 0.002), and uterine weight (p = 0.002). There was no association between the presence of pelvic adhesions (p = 0.91) or a personal history of cesarean section (p = 0.89) and receiving perioperative blood transfusion. When analyzing only the patients who underwent TLH, the presence of pelvic adhesion was found as a risk factor for perioperative blood transfusion (p = 0.024). The abdominal hysterectomy route, the presence ofa large uterus, and obesity are risk factors for receiving a blood transfusion. Early identification of the patient at risk of requiring perioperative blood transfusion provides better patient counseling and surgical preparation.
Highlights
In the United States, hysterectomy is one of the most common surgeries performed in gynecology [1]
The need for blood transfusion according to route of hysterectomy was as follows: Total abdominal hysterectomy (TAH): 34/263 (12.92 %), Total laparoscopic hysterectomy (TLH): 5/119 (4.2 %), Laparoscopic assisted vaginal hysterectomy (LAVH): 3/35 (8.57 %), and Vaginal hysterectomy (VH): 5/100 (5.0 %) (Table 2)
The mean estimated blood loss (EBL) in a total abdominal hysterectomy was 327.17 cc ± 306.30, which is 187.8 cc, 42 cc, and 128.8 cc greater than the mean EBL noted in TLH, LAVH, and VH, respectively
Summary
In the United States, hysterectomy is one of the most common surgeries performed in gynecology [1]. As per the Centers for Disease Control and Prevention (CDC), approximately 600,000 hysterectomies are done each year, and by the age of 60, more than 1/3 of all women have undergone a hysterectomy [2]. Hysterectomy is a relatively safe procedure regardless of the selected surgical route [3]. Hysterectomies, like other surgical procedures, carry the risk of blood transfusion, and these risks depend on several factors. It is important to identify these prior to surgery as perioperative blood transfusions should, when possible, be avoided. Despite the safeguards in place today, blood transfusions are not without risks such as acute transfusion reactions, medical errors, viral, and bacterial infections among others [4]
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