Effect of Perioperative Transfusion on Postoperative Morbidity Following Minimally Invasive Hysterectomy for Benign Indications

Abstract

Study objective: To examine the impact of perioperative allogeneic blood transfusion (ABT) on postoperative infectious wound occurrences, sepsis-related events. and venous thromboembolism.

Design: Retrospective cohort study.

Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

Patients: Patients who underwent a minimally invasive hysterectomy for benign indications between 2012 and 2016 were selected from the ACS-NSQIP. Patients with concurrent open hysterectomy, prolapse, or malignancy were excluded. Those with preoperative, intraoperative or postoperative red blood cell transfusion were considered positive for perioperative ABT.

Intervention: Minimally invasive hysterectomy for benign indications.

Measurements and main results: Univariate analyses were performed to determine associations of preoperative and intraoperative patient variables and postoperative outcomes with perioperative ABT. Multivariate analysis was completed to test the independent associations of perioperative ABT with outcomes while adjusting for possible confounders. Of the 90,231 patients who met our inclusion criteria, 1447 had a perioperative transfusion (1.6%). Perioperative ABT was associated with multiple preoperative variables. After multivariate analysis, perioperative ABT remained significantly associated with infectious wound events (adjusted odds ratio [aOR], 1.96; 95% confidence interval [CI], 1.9-2.58; p < .001), thromboembolic events (aOR, 2.75; 95% CI, 1.5-5.05; p = .001), and sepsis events (aOR, 6.49; 95% CI, 4.29-9.79, p < .001).

Conclusion: ABT is a commonly used to treat perioperative anemia in patients undergoing gynecologic surgery. The results of this study, however, show that perioperative ABT increases a patient's risk of postoperative complications following minimally invasive hysterectomy. Gynecologic surgeons should consider the use of alternative treatments for perioperative anemia, including intravenous iron supplementation, erythropoiesis-stimulating agents, normovolemic hemodilution, and preoperative hormonal suppression, to help reduce the morbidity associated with perioperative ABT.

Keywords: Anemia; Laparoscopic hysterectomy; Minimally invasive surgery; Postoperative morbidity; Transfusion.