Myomectomy associated blood transfusion risk and morbidity after surgery

Tana Kim, Mackenzie P. Purdy, Lauren Kendall-Rauchfuss, Elizabeth B. Habermann, Katherine A. Bews, Amy E. Glasgow, Zaraq Khan

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalFertility and sterility
DOIs
StateAccepted/In press - 2020

Keywords

  • ACS NSQIP
  • Myomectomy
  • blood transfusion
  • complications
  • morbidity

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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  • Cite this

    Kim, T., Purdy, M. P., Kendall-Rauchfuss, L., Habermann, E. B., Bews, K. A., Glasgow, A. E., & Khan, Z. (Accepted/In press). Myomectomy associated blood transfusion risk and morbidity after surgery. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2020.02.110