Prevalence and Associated Factors of Perioperative Blood Transfusion in Patients Undergoing Laparoscopic Hysterectomy for Benign Gynecologic Conditions

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Pairwa Jirakulsawas
Apichaya Pradyachaipimol
Sasikan Tangthasana
Jiraporn Luengmettakul


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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How to Cite
Jirakulsawas, P.; Pradyachaipimol, A. .; Tangthasana, S.; Luengmettakul, J. . Prevalence and Associated Factors of Perioperative Blood Transfusion in Patients Undergoing Laparoscopic Hysterectomy for Benign Gynecologic Conditions. Thai J Obstet Gynaecol 2024, 32, 214-224.
Original Article


Lykke R, Blaakaer J, Ottesen B, Gimbel H. Hysterectomy in Denmark 1977-2011: changes in rate, indications, and hospitalization. Eur J Obstet Gynecol Reprod Biol 2013;171:333-8.

Lycke KD, Kahlert J, Damgaard R, Mogensen O, Hammer A. Trends in hysterectomy incidence rates during 2000-2015 in Denmark: shifting from abdominal to minimally invasive surgical procedures. Clin Epidemiol 2021;13:407-16.

Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol 2013;122:233-41.

Gale J, Cameron C, Chen I, Guo Y, Singh SS. Increasing minimally invasive hysterectomy: A canadian academic health centre experience. J Obstet Gynaecol Can 2016;38:141-6.

Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015;2015:CD003677.

Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2009;144:3-7.

Saad-Naguib M, Ulker A, Timmons D, Grady M, Lederer M, Carugno J. Risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease in a teaching institution. Arch Gynecol Obstet 2022;305:103-7.

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: e2022.00013.

Tyan P, Taher A, Carey E, Amdur R, Messersmith C, Robinson HN, et al. Effect of perioperative transfusion on postoperative morbidity following minimally invasive hysterectomy for benign indications. J Minim Invasive Gynecol 2020;27:200-5.

Sordia-Hernandez LH, Rodriguez DS, Vidal-Gutierrez O, Morales-Martinez A, Sordia-Pineyro MO, Guerrero-Gonzalez G. Factors associated with the need for blood transfusion during hysterectomy. Int J Gynaecol Obstet 2012;118:239-41.

Matthews CA, Cohen S, Hull K, Ramakrishnan V, Reid N. Risk factors for blood transfusion in women undergoing hysterectomy for benign disease. J Gynecol Surg 2012.108-12.

Zewdie K, Genetu A, Mekonnen Y, Worku T, Sahlu A, Gulilalt D. Efficiency of blood utilization in elective surgical patients. BMC Health Serv Res 2019;19:804.

Yazdi AP, Alipour M, Jahanbakhsh SS, Gharavifard M, Gilani MT. A survey of blood request versus blood utilization at a university hospital in Iran. Arch Bone Jt Surg 2016;4:75-9.

Boriboonhirunsarn D, Chaopothong P, Jirasawas T. Blood transfusion in elective abdominal gynecologic surgery. J Gynecol Surg 2017;33: 231-5.

Ness PM, Rosche ME, Barrasso C, Luff RD, Johnson JW, Jr. The efficacy of type and screen to reduce unnecessary cross matches for obstetric patients. Am J Obstet Gynecol 1981;140:661-4.

Clarke-Pearson DL, Sullivan SA, Pierce SR, West LM. Preoperative evaluation and postoperative management. In: Berek JS, ed. Berek & Novak’s gynecology. 16th ed. Philadelphia: Lippincott Williams & Wilkins; 2020. p. 1309-413.

Maheux-Lacroix S, Lemyre M, Couture V, Bernier G, Laberge PY. Feasibility and safety of outpatient total laparoscopic hysterectomy. JSLS 2015;19:e2014 00251.

Murji A, Lam M, Allen B, Richard L, Shariff SZ, Austin PC, et al. Risks of preoperative anemia in women undergoing elective hysterectomy and myomectomy. Am J Obstet Gynecol 2019;221:629 e1- e18.

Maclaran K, Agarwal N, Odejinmi F. Perioperative outcomes in laparoscopic hysterectomy: identifying surgical risk factors. Gynecological Surgery 2016;13: 75-82.

Huang CY, Wu KY, Su H, Han CM, Wu PJ, Wang CJ, et al. Accessibility and surgical outcomes of transumbilical single-port laparoscopy using straight instruments for hysterectomy in difficult conditions. Taiwan J Obstet Gynecol 2014;53:471-5.

McGurk L, Oliver R, Odejinmi F. Laparoscopic supracervical hysterectomy for the larger uterus (> 500 g): a case series and literature review. Arch Gynecol Obstet 2017;295:397-405.

Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients. J Minim Invasive Gynecol 2014;21: 818-24.

Housmans S, Noori N, Kapurubandara S, Bosteels JJA, Cattani L, Alkatout I, et al. Systematic review and meta-analysis on hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) compared to laparoscopic hysterectomy for benign indications. J Clin Med 2020;9:3959.

Puisungnoen N, Yantapant A, Yanaranop M. Natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy versus total laparoscopic hysterectomy: A single-center retrospective study using propensity score analysis. Gynecol Minim Invasive Ther 2020;9:227-30.

Aldaghi T, Morteza GH, Kargari M. Forecasting the amount of blood ordered in the obstetrics and gynaecology ward with the data mining approach. Indian J Hematol Blood Transfus 2020;36:361-7.

Atrah HI, Galea G, Urbaniak SJ. The sustained impact of a group and screen and maximum surgical blood ordering schedule policy on the transfusion practice in gynaecology and obstetrics. Clin Lab Haematol 1995;17:177-81.

Woodrum CL, Wisniewski M, Triulzi DJ, Waters JH, Alarcon LH, Yazer MH. The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Hematology 2017;22:571-7.

Guduri PR, Shastry S, Raturi M, Shenoy A. Surgical blood ordering schedule for better inventory management: An experience from a tertiary care transfusion center. Med J Armed Forces India 2022;78:283-90.