Factors Associated With Blood Transfusion During Hysterectomy Are Identified

Several factors including existing comorbidities, surgical indication, and surgical approach may increase the need for blood transfusion during hysterectomy, according to new research.

To identify factors associated with the risk of blood transfusion, the researchers conducted a retrospective cohort study of US women who had a hysterectomy for a benign indication between 2011 and 2017.

The researchers selected nearly 171,940 study participants from the American College of Surgeons National Surgical Quality Improvement Program database by using Current Procedural Terminology codes. They then compared patients who had a blood transfusion within 30 days of hysterectomy with those who did not and used multivariate logistic regression analysis to identify clinical and surgical factors associated with blood transfusion.

Using these methods, the researchers found that 2.7% of the cohort had a blood transfusion. The transfusion rate was the highest in patients with uterine fibroids (4.3%) and the lowest in patients with genital prolapse (1.1%); the adjusted odds ratio (aOR) for transfusion after hysterectomy for uterine fibroids compared with after hysterectomy for genital prolapse was 1.36 (95% CI, 1.15-1.61). Moreover, the aOR for blood transfusion after abdominal vs laparoscopic hysterectomy was 5 (95% CI, 4.7-5.4), and the aOR for blood transfusion after vaginal vs laparoscopic hysterectomy was 1.87 (95% CI, 1.7-2.1).

Additional factors that predisposed patients to blood transfusion included age 40 to 49 years, non-White race, extremes of body mass index, current smoking, bleeding disorders, preoperative sepsis, and an American Society of Anesthesiologist score of 2 or more (P < .05). Comorbidities such as diabetes, hypertension, and congestive heart failure had also elevated the risk of blood transfusion.

In contrast, higher preoperative hematocrit levels had decreased the risk of blood transfusion (aOR, 0.84; 95% CI, 0.84-0.85, per percentage increase in hematocrit).

“These results may have implications for pre-operative patient counseling, perioperative care, and health system planning,” the researchers noted.

—Ellen Kurek

Reference:

Elfazari T, Nayak AL, Mallick R, Arendas K, Choudhry AJ, Chen I. Surgical indication and approach are associated with transfusion in hysterectomy for benign disease. JSLS. 2022;26(2):e2022.00013. doi:10.4293/JSLS.2022.00013