Routine Hematocrit After Elective Gynecologic Surgery

Abstract

The benefits and costs of many routine postoperative tests are undergoing more and more scrutiny as every possible avenue of cost-savings is explored. This review examined the cost-effectiveness of routine postoperative hematocrit after elective gynecologic surgery and identified factors that predict the need for transfusion. A computerized search of operating room records was used to identify all women who underwent elective gynecologic surgery during 1995. The charts of 1105 patients who met the minimal study requirements were reviewed. One hundred six of the 1105 operations involved more than one surgical approach, resulting in a total of 1211 procedures. Of these procedures, 485 (40 percent) were abdominal, 388 (32 percent) were vaginal, and 338 (28 percent) were laparoscopic. A total of 316 abdominal, 136 vaginal, and 39 laparoscopically assisted hysterectomies were performed. A routine hematocrit test was performed postoperatively in 761 cases (69 percent); the test was repeated at least once in 201 patients (18 percent). A postoperative hematocrit test was ordered more frequently for women who underwent abdominal hysterectomy than for those who underwent vaginal or laparoscopically assisted hysterectomy (94 percent, 58 percent, and 25 percent, respectively). Twenty-one of the 1105 women (1.9 percent) required blood transfusion for reasons related to their surgery. Five patients with preexisting anemia had a preoperative transfusion, eight patients received an intraoperative transfusion, and eight had a postoperative transfusion. The women needing blood transfusions were similar in all demographic characteristics to the 1084 women who did not require transfusion. An analysis of possible clinical risk factors for blood transfusion showed that decreased preoperative hematocrit, increased estimated operative blood loss and need for intravenous fluids, and decreased postoperative hematocrit were associated with and increased risk of transfusion (P < .05 for all). Size of the uterus was not a significant risk factor. Seventeen of the 21 women who required blood transfusion had undergone hysterectomy. The incidence of transfusion in the total group of 491 women who underwent hysterectomy was 3.4 percent (17 of 491). All eight women who needed a postoperative blood transfusion had a low postoperative hematocrit and exhibited symptoms of anemia. These women had longer hospital stays than patients who did not require transfusion. Using an average hospital charge for hematocrit and complete blood count for inpatient service of $26, the total charges for obtaining routine postoperative hematocrit tests for all study patients was $28,730. The women who had one or more hematocrit tests had actual charges of $25,012. Obstet Gynecol 2000;95:847–850