The incidence of transfusion and associated risk factors in pelvic reconstructive surgery

Pandya, Lopa K.; Lynch, Courtney D.; Hundley, Andrew F.; Nekkanti, Silpa; Hudson, Catherine

doi:10.1016/j.ajog.2017.07.005

Cited by 22 publications

(11 citation statements)

References 27 publications

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“…These include pelvic organ prolapse (POP), stress urinary incontinence (SUI) and sexual dysfunction [24,25]. POP is an extremely prevalent condition, with over 300,000 surgical procedures for prolapse repair performed annually in the United States [26]. The majority of surgeries for POP repair are performed on older post-menopausal women, and reoperation rate was reported to be as high as 30%.…”

Section: Introductionmentioning

confidence: 99%

Systemically transplanted mesenchymal stem cells induce vascular-like structure formation in a rat model of vaginal injury

Gropp

et al. 2019

PLoS ONE

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The beneficial effect of mesenchymal stem cells (MSCs) on wound healing is mostly attributed to a trophic effect that promotes angiogenesis. Whether MSCs can contribute to the formation of new blood vessels by direct differentiation is still controversial. Pelvic floor dysfunction (PFD) is a group of disorders that negatively affect the quality of women’s lives. Traditional vaginal surgical repair provides disappointing anatomical outcome. Stem cell transplantation may be used to supplement surgery and improve its outcome. Here we aimed to examine the engraftment, survival, differentiation and angiogenic effect of transplanted MSCs in a vaginal injury rat model. MSCs were obtained from the bone marrow of Sprague Drawley (SD) rats, expanded and characterized in vitro . The MSCs expressed CD90 and CD29, did not express CD45, CD34, CD11b and CD31 and could differentiate into osteogenic, chondrogenic and adipogenic lineages. Cells were labeled with either PKH-26 or GFP and transplanted systemically or locally to female SD rats, just after a standardized vaginal incision was made. Engraftment after local transplantation was less efficient at all-time points compared to systemic administration. In the systemically transplanted animal group, MSCs migrated to the injury site and were present in the healed vagina for at least 30 days. Both systemic and local MSCs transplantation promoted host angiogenesis. Systemically transplanted MSCs created new vascular-like structures by direct differentiation into endothelium. These findings pave the way to further studies of the potential role of MSCs transplantation in improving surgical outcome in women with PFD.

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Section: Introductionmentioning

confidence: 99%

Systemically transplanted mesenchymal stem cells induce vascular-like structure formation in a rat model of vaginal injury

Gropp

et al. 2019

PLoS ONE

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“…Here, we were motivated to determine which factors may predict need for transfusion, with the goal of eliminating unnecessary pre-operative T&S testing. This is a relevant issue in the gynecologic oncology setting in which up to 14% of patients require perioperative transfusion, as compared to 1-2% of patients undergoing surgery on a benign gynecology service [4,17]. We found an overall transfusion rate of 6.7%.…”

Section: Discussionmentioning

confidence: 69%

Which patients on a gynecologic oncology service will require perioperative transfusion? A single-center retrospective cohort study

2021

Clinical and Experimental Obstetrics & Gynecology

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The purpose of this study was to determine which patient-or surgeryrelated factors are predictive of need for perioperative transfusion to avoid obtaining unnecessary pre-operative type and screens (T&S). We conducted an observational retrospective cohort study of 1200 women ≥ 18 years old undergoing gynecologic surgery for benign, possibly benign, or malignant indications on a gynecologic oncology service at a university medical center from 2009-2016. A logistic regression model was used to examine patient-related and surgeryrelated variables predictive of outcome of transfusion. Independent variables included patient demographics, comorbidities, and surgical indication surgical route, and surgical type. Dependent variable was transfusion outcome (T&S only, conversion to type and cross (T&C), or transfusion). Eight hundred ninety-nine (74.9%) women underwent pre-operative T&S, of which 118 (9.8%) were converted to T&C, and 80 (6.7%) received a transfusion of blood or blood products. Cancer indication, major surgery, and preoperative hematocrit less than 36% were significantly associated with need for transfusion (P = 0.002, P < 0.0001, P < 0.0001, respectively). Patients with a benign indication undergoing minor procedures and with normal preoperative hematocrit are least likely to require transfusion.

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“…11 Other research regarding blood transfusion and prolapse repair does not specify route of hysterectomy but cites transfusion rates of up to 4%. 1,3,10 Previous authors have evaluated the utility of postoperative hemoglobin testing after minimally invasive sacrocolpopexy with or without hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 Additionally, preoperative anemia, history of coagulopathy, and African American or Hispanic ethnicity have been noted as risk factors for postoperative blood transfusion. [7][8][9][10] Whereas the utility of routine CBC after benign gynecologic surgery, total laparoscopic hysterectomy, and minimally invasive sacrocolpopexy have been assessed, we lack similar research surrounding vaginal hysterectomy with vaginal prolapse repairs. 1,2,6,9 The large dissection along mucosal surfaces associated with native tissue prolapse repairs may render this patient population at higher risk of postoperative bleeding complications.…”

mentioning

confidence: 99%

Clinical Benefit of Routine Postoperative Hemoglobin Testing After Vaginal Hysterectomy and Reconstruction for Symptomatic Pelvic Organ Prolapse

Aldrich¹,

Pauls²

2021

Female Pelvic Med Reconstr Surg

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Objectives:The objective of this study was to determine the clinical benefit of a routine complete blood count (CBC) on the first postoperative day after vaginal hysterectomy with reconstruction.Methods: This retrospective cohort study evaluated patients undergoing vaginal hysterectomy with native tissue prolapse repair between 2014 and 2019. Baseline and operative data, preoperative and postoperative blood counts, signs of anemia, and complications were recorded. Objective signs of anemia included tachycardia, hypotension, and low urine output. Subjective signs of anemia included dizziness, weakness, pallor, and diaphoresis. Complications, such as blood transfusions, additional testing, and readmission, were recorded.Results: Five hundred and seventy patients had a postoperative CBC. The median preoperative hemoglobin level was 13.5 g/dL (min, 9.4; max, 16.9). Ninety-seven (17%) patients had a postoperative hemoglobin of 10 g/dL or less, with a median hemoglobin of 11.2 g/dL (min, 5.6; max, 14.9). Signs of anemia occurred in 72 (12.6%) patients: 64 (11.2%) showing objective signs, 13 (2.3%) reporting subjective symptoms, and 5 (0.8%) noting both. The most common objective sign was hypotension (n = 40; 63.5%). Five women received transfusions (0.9%). All patients receiving a blood transfusion showed objective signs of anemia; 3 (50%) patients had objective and subjective signs. Twenty-one (3.7%) patients had more than 1 CBC test during admission; 9 (42.9%) of these women were asymptomatic and had no further intervention. There were no readmissions related to postoperative anemia. Conclusions:Patients that require intervention for anemia after vaginal hysterectomy and reconstruction will manifest clinical signs or symptoms. Routine CBC testing in this cohort did not provide benefit and led to superfluous procedures in the vast majority of participants.

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The incidence of transfusion and associated risk factors in pelvic reconstructive surgery

Cited by 22 publications

References 27 publications

Systemically transplanted mesenchymal stem cells induce vascular-like structure formation in a rat model of vaginal injury

Systemically transplanted mesenchymal stem cells induce vascular-like structure formation in a rat model of vaginal injury

Which patients on a gynecologic oncology service will require perioperative transfusion? A single-center retrospective cohort study

Clinical Benefit of Routine Postoperative Hemoglobin Testing After Vaginal Hysterectomy and Reconstruction for Symptomatic Pelvic Organ Prolapse

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