Risk Factors for Perioperative Blood Transfusion in Patients Undergoing Hysterectomy for Benign Disease in a Teaching Institution

Abstract

Purpose: The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease. Methods: 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. Results: 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) Conclusion: The abdominal hysterectomy route, the presence of a 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.

The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult

“…It is generally accepted that obesity regardless of specific class is associated with perioperative complications and increased operative time that increases exposure time to anesthesia as well [43]. Likewise, although more evidence is necessary to define a certain uterine weight as independently associated with perioperative complications, uterine weight greater than 250 g has generally been accepted as a cutoff for surgical difficulty, complications, need for blood transfusion, and aggregate risk [44–45]. Prior surgeries and their sequelae have also been implicated in the complexity of performing laparoscopic hysterectomies.…”