Perioperative Transfusion Risk for Benign Minimally Invasive Hysterectomy

Objectives: To identify transfusion risk for minimally invasive hysterectomy (MIH) for pelvic organ prolapse (POP) compared to other benign indications. Our secondary objective was to determine risk factors for perioperative transfusion following MIH for POP.

Methods: Using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program Gynecology Participant Use Data File, a retrospective cohort study was performed to determine the risk of perioperative blood transfusion following MIH for benign indications. MIH were identified using CPT codes, and surgical indications were classified according to ICD-9 and 10 codes. Gynecologic malignancy risk-reducing indications were categorized as prophylactic. Hysterectomy routes included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy, and vaginal hysterectomy. Hysterectomies for malignancy were excluded. Perioperative transfusion was defined as blood transfusion given intraoperatively or within 30-days postoperatively. Multivariable logistic regressions were performed using variables with p< 0.10 on bivariate analysis.

Results: 282,124 patients underwent MIH for benign gynecologic indications. Patients undergoing MIH for POP compared to other benign indications were older, had lower BMI, and were less likely to currently smoke (p < 0.001). Overall transfusion rate for benign MIH was 1.2% (3,390), and transfusion rates differed significantly by surgical indication (p < 0.001). Patients undergoing MIH for POP had a low rate of transfusion (0.7%) compared to other benign indications like anemia (15.9%), fibroids (1.8%), and menstrual disorders (1.5%). Factors that increased the risk of transfusion after MIH for POP were ASA Class 4 (aOR 3.24), laparoscopic assisted vaginal (aOR 1.82) or vaginal (aOR 2.13) route of surgery.

Conclusions: Patients undergoing surgery for POP had significantly lower rates of transfusion compared to other benign indications. Total laparoscopic and laparoscopic supracervical routes of surgery were particularly low in risk. Aggressive preoperative precautions, including labs and redundant IV access, are likely excessive in this population.