Myomectomy associated blood transfusion risk and morbidity after surgery

Objective: To evaluate blood transfusion risks and the associated 30-day postoperative morbidity after myomectomy. Design: Retrospective cohort study. Setting: Not applicable. Patient(s): Women who underwent myomectomies for symptomatic uterine fibroids (N = 3,407). Intervention(s): Blood transfusion during or within 72 hours after myomectomy. Main Outcome Measure(s): The primary outcomes were rate of blood transfusion with myomectomy and risk factors associated with receiving a transfusion. The secondary outcome was 30-day morbidity after myomectomy. Result(s): The overall rate of blood transfusion was 10% (hysteroscopy, 6.7%; laparoscopy, 2.7%; open/abdominal procedures, 16.4%). Independent risk factors for transfusion included as follows: black race (adjusted odds ratio [aOR] 2.27, 95% confidence interval [CI] 1.62–3.17) and other race (aOR 1.77, 95% CI 1.20–2.63) compared with white race; preoperative hematocrit <30% compared to ≥30% (aOR 6.41, 95% CI 4.45–9.23); preoperative blood transfusion (aOR 2.81, 95% CI 1.46–5.40); high fibroid burden (aOR 1.91, 95% CI 1.45–2.51); prolonged surgical time (fourth quartile vs. first quartile aOR 11.55, 95% CI 7.05–18.93); and open/abdominal approach (open/abdominal vs. laparoscopic aOR 9.06, 95% CI 6.10–13.47). Even after adjusting for confounders, women who required blood transfusions had an approximately threefold increased risk for experiencing a major postoperative complication (aOR 2.69, 95% CI 1.58–4.57). Conclusion(s): Analysis of a large multicenter database suggests that the overall risk of blood transfusion with myomectomy is 10% and is associated with an increased 30-day postoperative morbidity. Preoperative screening of women at high risk for transfusion is prudent as perioperative transfusion itself leads to increased major postoperative complications.