Predictors of Transfusion Requirement Among Patients Who Undergo Hysterectomy for Benign Disease

Abstract

Abstract

Objective: The purpose of this study was to determine preoperative factors that could predict the need for blood transfusion during hysterectomy. Design: The study was designed as a retrospective case–control study. Methods: A retrospective review of hysterectomies from January 2000 to July 2005 was performed. Transfused (137) and randomly selected nontransfused (304) patients were analyzed in an unmatched case-control manner. Preoperative hematocrits (HCTs), types of hysterectomy, surgical indications, physician–estimated blood loss (EBL), uterine weights, Charlson Comorbidity Index scores, and other demographic factors, in transfused and nontransfused patients were analyzed. Results: Mean HCT was lower in the transfused group than in the nontransfused group (34.0 versus 38.8; p<0.001). Patients with a preoperative HCT <30 required transfusion more often than those with a preoperative HCT ≥30 (78% versus 25%; odds ratio [OR] 10.6). Mean EBL was greater in the transfused group than in the nontransfused group (870 mL versus 291 mL). Patients having surgeries with EBLs>1000 mL had an OR for transfusion of 52.1. There was an increased incidence of transfusion when the surgical indication was fibroid growths or menorrhagia rather than prolapse (OR 3.2; confidence interval [CI]: 1.4–7.4), and the risk of needing a transfusion was higher in patients who had had abdominal hysterectomy than in those who had had vaginal or laparoscopic hysterectomy (OR 3.4; C.I. 2.0–5.7). There were no differences in baseline age, race, body mass index (BMI), or tobacco use between transfused and nontransfused patients. Conclusions: Low preoperative HCT, particularly an HCT<30, is associated with increased risk of the need for a transfusion. Anemic patients are more likely to have open procedures and higher EBLs for larger uteri. (J GYNECOL SURG 28:1)