Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a NSQIP Study

Background Uterine fibroids are the most common benign tumors affecting females. Laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of myomectomy is excessive bleeding. However, risk factors for hemorrhage in laparoscopic myomectomy are not well studied and no risk stratification tool specific to the need for blood transfusion in laparoscopic myomectomy currently exists in the literature. Study Objectives To identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool for the risk of blood transfusion. Design Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. Women who underwent laparoscopic (conventional or robotic) myomectomy were included. Women who received ≥1 blood transfusion within 72 hours after laparoscopic myomectomy start time were compared with those who did not require blood transfusion. Multivariable analysis was performed to identify risk factors independently associated with the risk of transfusion. Two risk stratification tools for the need for blood transfusion were developed based on multivariable results: 1. based on preoperative factors, 2. based on preoperative and intraoperative factors. Results During the study period 11,498 women underwent laparoscopic myomectomy. Of these 331(2.9%) required transfusion. In multivariable regression analysis of preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, ASA III/IV and preoperative hematocrit value ≤35.0% were independently associated with risk of transfusion. Identified intraoperative factors included specimen weight >250 grams or ≥5 intramural myomas and operation time ≥197 minutes. A risk stratification tool was developed, assigning points based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of points. Conclusion We identified preoperative and intraoperative independent risk factors for blood transfusion among women undergoing laparoscopic myomectomy. A risk stratification tool for the risk of blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool. Uterine fibroids are the most common benign tumors affecting females. Laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of myomectomy is excessive bleeding. However, risk factors for hemorrhage in laparoscopic myomectomy are not well studied and no risk stratification tool specific to the need for blood transfusion in laparoscopic myomectomy currently exists in the literature. To identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool for the risk of blood transfusion. Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. Women who underwent laparoscopic (conventional or robotic) myomectomy were included. Women who received ≥1 blood transfusion within 72 hours after laparoscopic myomectomy start time were compared with those who did not require blood transfusion. Multivariable analysis was performed to identify risk factors independently associated with the risk of transfusion. Two risk stratification tools for the need for blood transfusion were developed based on multivariable results: 1. based on preoperative factors, 2. based on preoperative and intraoperative factors. During the study period 11,498 women underwent laparoscopic myomectomy. Of these 331(2.9%) required transfusion. In multivariable regression analysis of preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, ASA III/IV and preoperative hematocrit value ≤35.0% were independently associated with risk of transfusion. Identified intraoperative factors included specimen weight >250 grams or ≥5 intramural myomas and operation time ≥197 minutes. A risk stratification tool was developed, assigning points based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of points. We identified preoperative and intraoperative independent risk factors for blood transfusion among women undergoing laparoscopic myomectomy. A risk stratification tool for the risk of blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool.