Myomectomy associated blood transfusion risk and morbidity after surgery

Kim, Tana; Purdy, MacKenzie P.; Kendall-Rauchfuss, Lauren; Habermann, Elizabeth B.; Bews, Katherine A.; Glasgow, Amy E.; Khan, Zaraq

doi:10.1016/j.fertnstert.2020.02.110

Cited by 43 publications

(32 citation statements)

References 35 publications

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“…Blood transfusion is not without risk; almost 20% of the transfusions lead to an adverse event [11]. Potential complications include allergic reaction, fever, metabolic derangement, hemolytic reaction, cardiac overload, acute lung injury, blood-borne illness, immunosuppression leading to higher surgical-site infections and tumor recurrence in patients with cancer, and death [3,12]. In addition, 8.1% of the women who undergo transfusion develop clinically significant alloantibodies, which carry significant implications in future pregnancies and future transfusions [11].…”

Section: Discussionmentioning

confidence: 99%

“…The most common complication of a myomectomy is extensive blood loss leading to blood transfusion [3]. This bleeding, ultimately resulting in transfusion, can occur either intraoperatively or postoperatively.…”

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confidence: 99%

“…This bleeding, ultimately resulting in transfusion, can occur either intraoperatively or postoperatively. The rates of transfusion during myomectomy vary widely in the literature, from 2.7% to 20%, and many studies have tried to identify the risk factors for estimating perioperative blood loss and need for transfusion [3,4]. The modality of myomectomy correlates with risk of transfusion.…”

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confidence: 99%

“…Stanhiser et al [5] found that laparotomy carried 4.8 times (95% confidence interval [CI], 3.8−5.8) the risk of transfusion over a laparoscopic approach [5]. A large database study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) found the rate of transfusion to be 6.7% with hysteroscopic, 2.7% with laparoscopic, and 16.4% with open/abdominal myomectomies when both emergent and elective cases were included [3]. Other risk factors include preoperative anemia and specific myoma characteristics.…”

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confidence: 99%

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A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy

Klebanoff

Marfori²,

Sparks

et al. 2021

Journal of Minimally Invasive Gynecology

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We sought to identify the variables independently associated with intra/postoperative blood transfusion at the time of myomectomy. We further hoped to develop an accurate prediction model using preoperative variables to categorize an individual's risk of blood transfusion during myomectomy. Design: Case-control study. Setting: Not applicable to this study, which used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients: Women who underwent an open/abdominal or laparoscopic (robotic or conventional) myomectomy between 2014 and 2017 at participating ACS-NSQIP sites. Intervention: The primary dependent variable was occurrence of intra/postoperative bleeding requiring blood transfusion. Patient demographics, clinical characteristics, preoperative comorbidities, intraoperative variables, and additional 30-day postoperative outcomes were compared at the bivariable level. For the prediction-model development, only variables that can be reasonably known before surgery were included. Variables associated with intra/postoperative bleeding were entered into 2 separate multivariable logistic regression models. Validation of our prediction model was performed internally using 250 bootstrapped iterations of 50% subsamples drawn from the overall population of myomectomy cases from the ACS-NSQIP database. Measurements and Main Results: We identified 6387 myomectomies performed during the defined study period. The most common race in our population was black/African American (45.7%), and most of the patients (57.5%) received an open/abdominal route of myomectomy. A total of 623 patients who underwent myomectomy (9.8%) experienced intraoperative/postoperative bleeding with a need for blood transfusion. At the bivariable level, we identified several variables independently associated with the need for blood transfusion at the time of myomectomy. In using only those variables that can be reasonably known before surgery to develop our prediction model, additional multivariable logistic regression elucidated black race, need for preoperative blood transfusion, planned abdominal/open route of surgery, and preoperative hematocrit value as independently associated with blood transfusion. Conclusion:We identified a number of perioperative variables associated with intraoperative or postoperative bleeding requiring blood transfusion at the time of myomectomy. We subsequently created a model that accurately predicts individual bleeding risk from myomectomy, using variables that are reasonably apparent preoperatively. Making this prediction model clinically available to gynecologic surgeons will serve to improve the care of women undergoing myomectomy. Journal of Minimally Invasive Gynecology (2021) 00, 1−9.

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Section: Discussionmentioning

confidence: 99%

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A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy

Klebanoff

Marfori²,

Sparks

et al. 2021

Journal of Minimally Invasive Gynecology

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“…In fact, at the moment, uterine leiomyomas represent the most common indication for hysterectomy in the world. However, it represents itself an additional problem concerning uterine fibroids and also the less invasive myomectomy leads to a serious postoperative morbidity [ 32 , 33 ]. Hysterectomy exerts also a very significant economic impact on the healthcare system all over the world, reaching an amount almost equal to $2.2 billion/year for the United States of America alone [ 34 ].…”

Section: Uterine Leiomyoma: a Typical Fibrotic Pathologymentioning

confidence: 99%

Macrophages and Immune Responses in Uterine Fibroids

Zannotti

Greco

Pellegrino

et al. 2021

Cells

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Uterine fibroids represent the most common benign tumors of the uterus. They are considered a typical fibrotic disorder. In fact, the extracellular matrix (ECM) proteins—above all, collagen 1A1, fibronectin and versican—are upregulated in this pathology. The uterine fibroids etiology has not yet been clarified, and this represents an important matter about their resolution. A model has been proposed according to which the formation of an altered ECM could be the result of an excessive wound healing, in turn driven by a dysregulated inflammation process. A lot of molecules act in the complex inflammatory response. Macrophages have a great flexibility since they can assume different phenotypes leading to the tissue repair process. The dysregulation of macrophage proliferation, accumulation and infiltration could lead to an uncontrolled tissue repair and to the consequent pathological fibrosis. In addition, molecules such as monocyte chemoattractant protein-1 (MCP-1), granulocyte macrophage-colony-stimulating factor (GM-CSF), transforming growth factor-beta (TGF-β), activin A and tumor necrosis factor-alfa (TNF-α) were demonstrated to play an important role in the macrophage action within the uncontrolled tissue repair that contributes to the pathological fibrosis that represents a typical feature of the uterine fibroids.

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Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double‐blind clinical trial

Mansour‐Ghanaei

Hosseinzadeh

Sharami

et al. 2022

Health Science Reports

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Background Uterine fibroid is a common benign pelvic tumor and abdominal myomectomy may cause excessive intraoperative bleeding, which may lead to adverse outcomes. Objective This study was planned to evaluate the effectiveness of the injection of lidocaine plus epinephrine to reduce intraoperative bleeding in abdominal myomectomy. Methods During October 2019 and May 2020, 60 eligible women with uterine fibroids were enrolled in a randomized controlled trial. Our patients were divided into two groups of lidocaine plus epinephrine defined as Group L and placebo defined as Group P. In group L, lidocaine 3 mg/kg plus 0.5 ml of adrenaline which reached to 50 cc with saline solution and in group P, 50 ml of normal saline was used. Both the combined solution and normal saline were infiltrated to the serous and myometrium above and around the fibroid before incision. Patients' demographic data, total operative time, hemoglobin changes, and the degree of surgical difficulty were evaluated and compared between the two groups. Results There was no significant difference between the two groups in terms of demographic data. Hemoglobin changes ( p 0.0001) and the degree of surgery difficulty ( p = 0.01) were significantly lower in Group L compared with Group P. In each group the drop in hemoglobin levels from baseline to 4 h postoperatively was significant ( p 0.0001). A significantly meaningful correlation was reported between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids ( p < 0.05). While a negative correlation was found regarding gravidity and surgery difficulty ( r = −0.413, p = 0.02). Surgery duration was longer in Group P compared with Group L 70.66 ± 19.85 versus 66.16 ± 14.48, respectively, but with no significant difference ( p = 0.32). No significant adverse reaction or serious complication was reported in the two groups. Hemodynamic parameters were kept in the normal range throughout the surgery. Conclusion A combination of lidocaine plus epinephrine during abdominal myomectomy appears to be a safe and effective method in reducing blood loss.

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Myomectomy associated blood transfusion risk and morbidity after surgery

Cited by 43 publications

References 35 publications

A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy

A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy

Macrophages and Immune Responses in Uterine Fibroids

Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double‐blind clinical trial

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