The Utility of Postoperative Hemoglobin Testing for Benign Hysterectomy and Myomectomy

Abstract

Objective:

To evaluate the prevalence of a significant decrease in hemoglobin, defined as a drop of ≥2 g/dL, on postoperative day 1 after benign hysterectomy and myomectomy and to compare subsequent interventions on those with and without significant decrease.

Methods:

This is a retrospective cohort study. Operative notes and clinical encounters up to 6 weeks after surgery were reviewed. Patients undergoing laparoscopic, robotic-assisted, abdominal, or vaginal hysterectomy or myomectomy from 1/2014 to 1/2019 at a single tertiary referral center were included. Patients with known malignancy, hysteroscopic or concomitant cesarean surgeries were excluded. Hemoglobin was compared pre- and postoperatively. Postoperative interventions were defined as transfusion, imaging, reoperation, repeat lab draw, and readmission.

Results:

A total of 1120 patients met inclusion criteria and 984 had pre- and postoperative labs drawn. A total of 41% (400/984) had a decrease in hemoglobin ≥2 g/dL. A decrease was least common with the laparoscopic route. Those with a significant hemoglobin drop were older (47.6 vs. 45.4 years, p = 0.0014) and noted to have a lower body mass index (31 vs. 33, p < 0.001), higher preoperative hemoglobin (12.8 vs. 11.5, p < 0.001) and larger estimated blood loss (358 vs. 234 ml, p < 0.001) There was no difference in postoperative transfusion, imaging, reoperation, or readmission between those with and without a significant hemoglobin decrease; however, there was an increase in the number of additional lab draws.

Conclusion:

There is limited utility in measuring hemoglobin routinely after benign gynecological surgery, as there were no additional interventions performed in those with significant decrease other than increased lab draws.