Prevalence and Associated Factors of Perioperative Blood Transfusion in Patients Undergoing Laparoscopic Hysterectomy for Benign Gynecologic Conditions
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Abstract
Objectives: To determine the prevalence and the associated factors of perioperative blood transfusion and to evaluate the efficiency of blood ordering and utilization in patients undergoing laparoscopic hysterectomy for benign gynecologic conditions.
Materials and Methods: A cross-sectional retrospective study was conducted. The medical records of 974 patients who underwent laparoscopic hysterectomy for benign gynecologic conditions from July 2016 through October 2022 were reviewed. The possible associated factors for blood transfusion including demographic data, clinical diagnosis, preoperative and intraoperative data were retrieved and evaluated. Blood utilization indicators such as crossmatch-to-transfusion ratio (C/T ratio), transfusion index (TI), and transfusion probability (%T) were also calculated.
Results: The overall perioperative transfusion rate was 19.4% (189/974). In multivariable regression analysis, patients who had preoperative anemia (adjusted odds ratio (aOR) 6.89; 95% confidence interval (CI) 4.56-10.43), estimated blood loss ≥ 300 milliliters (aOR 8.64; 95%CI 5.46-13.69), uterine size ≥ 500 grams (aOR 1.99; 95%CI 1.23-3.20) and presence of pelvic adhesion (aOR 2.01; 95%CI 1.31-3.09) were independently associated with perioperative blood transfusion. Moreover, natural orifice trans-luminal endoscopic surgery trended towards a lower blood transfusion rate than total laparoscopic hysterectomy (aOR 0.43; 95%CI 0.21-0.89). For blood utilization indicators: C/T ratio was 6.15, TI was 0.35, and %T was 19.4%.
Conclusion: Preoperative anemia, higher blood loss, large uterine size, and pelvic adhesion were transfusion risk factors in patients undergoing laparoscopic hysterectomy. Blood utilization indicators were low, indicating that routine blood crossmatching might be unnecessary for all patients.
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