Predicting postoperative day 1 hematocrit levels after hysterectomy

Rahman, Sara H.; Mayer, Sarah; Corcoran, Katie E.; Mayer, Allan R.; Shepherd, Jonathan

doi:10.1016/j.ajog.2018.04.059

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Surgical route was notably divergent: whereas the original study included only abdominal, laparoscopic, laparoscopy‐assisted vaginal, and vaginal hysterectomies, the present dataset included predominantly robotic hysterectomies that were not included in the original trial. In a similar analysis, however, Rahman et al 1 reported that the route of surgery did not significantly impact accuracy 1 . They also conducted their analysis both including and excluding robotic hysterectomies from their dataset, which did not alter the accuracy of the Swenson model.…”

Section: Discussionmentioning

confidence: 96%

“…Every year, approximately 600 000 hysterectomies are performed in the United States 1 . Although most of these cases are performed for benign reasons, a few are performed for malignant indications.…”

Section: Introductionmentioning

confidence: 99%

“…Svenson et al 3 found that, in their internal validation set, the model predicted the actual POD1 hematocrit value to within ±4% for more than 90% of cases. A subsequent study performed by Rahman et al 1 validated the Swenson model at a different facility. Whereas the Swenson study 3 was conducted in a facility that performed only abdominal, laparoscopic or vaginal hysterectomies, the Rahman study 1 included a large number of robotic hysterectomies.…”

Section: Introductionmentioning

confidence: 99%

“…A subsequent study performed by Rahman et al 1 validated the Swenson model at a different facility. Whereas the Swenson study 3 was conducted in a facility that performed only abdominal, laparoscopic or vaginal hysterectomies, the Rahman study 1 included a large number of robotic hysterectomies. In the latter validation study, the model predicted POD1 hematocrit to within ±5% for approximately 76% of cases, which was significantly less accurate than observed in the initial dataset.…”

Section: Introductionmentioning

confidence: 99%

“…In the latter validation study, the model predicted POD1 hematocrit to within ±5% for approximately 76% of cases, which was significantly less accurate than observed in the initial dataset. Rahman et al 1 concluded that the model was more useful as a screening tool for identifying actual hematocrit levels of less than 30% when the predicted hematocrit is below 35%.…”

Section: Introductionmentioning

confidence: 99%

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Predicting postoperative day 1 hematocrit levels after hysterectomy for malignant indication: Validating a previously published model

Kailasam

Brodeur

Mayer

et al. 2020

Intl J Gynecology & Obste

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Objective To determine whether the Swenson model of postoperative day 1 (POD1) hematocrit after benign hysterectomy is applicable to gynecologic oncology hysterectomies. Methods Data were retrospectively collected from cases of hysterectomy with malignant pathology in Hartford, USA, from 2014 to 2016. Predicted POD1 hematocrit was compared with actual hematocrit. ROC curve analysis was used to determine the optimal cut‐off point for predicting hematocrit levels of 30% or less. Results Among 107 women, mean age was 62.9 years and body mass index was 34.0. Most underwent robotic (44.9%) or abdominal (43.9%) hysterectomy. The published equation correctly predicted hematocrit to within ±5% for 83.2% of women, which was less accurate than observed in the original validation set. The equation was more likely to underestimate lower hematocrit levels, adding safety to its use. By ROC curve analysis, the best cut‐off point for predicting actual hematocrit above 30% was predicted hematocrit 32.3% (100% specificity). Conclusion The Swenson equation predicted POD1 hematocrit less accurately in the current dataset. As a screening tool for hematocrit below 30%, however, ordering postoperative hematocrit is probably unnecessary if the predicted value is 32.3% or higher. This equation should be used as a screening tool to reduce unnecessary laboratory tests.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predicting postoperative day 1 hematocrit levels after hysterectomy for malignant indication: Validating a previously published model

Kailasam

Brodeur

Mayer

et al. 2020

Intl J Gynecology & Obste

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Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting

Grimes

Clare

Meriwether

et al. 2022

Journal of Gynecologic Surgery

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How Much Does Intravenous Fluid Cause Hematocrit to Drop? Improving Interpretation of Hematocrit Toward Better Post-Hemorrhage Care

Qureshi,

Bloom,

Pevnick

2024

Military Medicine

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Introduction Hemorrhage is assessed, at least in part, via hematocrit testing. To differentiate unexpected drops in hematocrit because of ongoing hemorrhage versus expected drops as a result of known hemorrhage and intravenous fluid administration, we model expected post-operative hematocrit values accounting for fluid balance and intraoperative estimated blood loss (EBL) among patients without substantial post-operative bleeding. Materials and Methods We reviewed patient-level data from the electronic health record of an academic medical center for all non-pregnant adults admitted for elective knee or hip arthroplasty from November 2013 to September 2022 who did not require blood products. We used linear regression to evaluate the association between post-operative hematocrit and predictor variables including pre-operative hematocrit, intraoperative net fluid intake, blood volume, time from surgery to lab testing, EBL, patient height, and patient weight. Results We included 6,648 cases. Mean (SD) estimated blood volume was 4,804 mL (1023), mean net fluid intake was 1,121 mL (792), and mean EBL was 144 mL (194). Each 100 mL of EBL and 1,000 mL net positive fluid intake was associated with a decrease of 0.52 units (95% CI, 0.51-0.53) and 2.4 units (2.2-2.7) in post-operative hematocrit. Pre-operative hematocrit was the strongest predictor of post-operative hematocrit. Each 1-unit increase in pre-operative hematocrit was associated with a 0.70-unit increase (95% CI, 0.67-0.73) in post-operative hematocrit. Our estimates were robust to sensitivity analyses, and all variables included in the model were statistically significant with P <.005. Conclusion Patient-specific data, including fluid received since the time of initial hemorrhage, can aid in estimating expected post-hemorrhage hematocrit values, and thus in assessing for the ongoing hemorrhage.

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Predicting postoperative day 1 hematocrit levels after hysterectomy

Cited by 3 publications

References 12 publications

Predicting postoperative day 1 hematocrit levels after hysterectomy for malignant indication: Validating a previously published model

Predicting postoperative day 1 hematocrit levels after hysterectomy for malignant indication: Validating a previously published model

Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting

How Much Does Intravenous Fluid Cause Hematocrit to Drop? Improving Interpretation of Hematocrit Toward Better Post-Hemorrhage Care

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