New tool predicts blood transfusion needs in laparoscopic myomectomy

In a recent study published in the American Journal of Obstetrics & Gynecology, investigators developed and tested a stratification tool for identification of the need for blood transfusion following laparoscopic myomectomy.¹

Uterine fibroids impact up to 70% of White women and over 80% of Black women by the age of 50 years. One study found a prior fibroid tumor diagnosis in 35% of premenopausal women, with most US women developing uterine fibroids before menopause.² Additionally, tumors developed earlier in Black women than White women.

Treatment methods include medical, procedural, and surgical options. Hysterectomy is considered the definitive treatment, and myomectomy is utilized for women wishing for uterus preservation.¹

To reduce blood loss, the drop in hemoglobin level, length of hospital stay, and postoperative pain, patients will often undergo a laparoscopic myomectomy. However, challenges in controlling blood loss during a myomectomy remain.

An estimated 10% of patients undergoing myomectomy receive a blood transfusion, and there are currently few established risk factors for laparoscopic myomectomy. Development of a stratification tool for identification of the need for blood transfusion is necessary.

Investigators conducted a retrospective cohort study to identify risk factors for blood transfusion during laparoscopic myomectomies. Data was obtained from the National Surgical Quality Improvement Program (NSQIP) database, which included data from nearly 700 hospitals.¹

Patients receiving a conventional or robotic-assisted laparoscopic myomectomy from 2012 to 2020 were included in the NSQIP. Current Procedural Terminology codes were used to identify procedures, with open, vaginal, and hysteroscopic myomectomies excluded. Patients requiring preoperative blood transfusion were also excluded.

Women receiving at least 1 blood transfusion within 72 hours after the start of a laparoscopic myomectomy were compared to those without any blood transfusions. Relevant data included baseline demographics, comorbidities, preoperative clinical characteristics, intraoperative characteristics, and postoperative complications.

There were 11,496 women who underwent laparoscopic myomectomies included in the final analysis, 2.9% of whom required a blood transfusion. Blood transfusion rates ranged from 2.2% in 2019 to 4.6% in 2013.¹

Women requiring a blood transfusion were less often White and more often Black. These women also had a higher proportion of bleeding disorders, specimens weighing over 250 g, and intramural myomas. Longer mean surgeries were reported among women with blood transfusions vs without, at 251 vs 162.1 minutes, respectively.

The multivariable analysis included non-Hispanic White race, Black race, bleeding disorder diagnosis, American Society of Anesthesiologists (ASA) class 3 or 4, specimen weight over 250 g or at least 5 intramural myomas, preoperative anemia, and operation time over 197 minutes as risk factors for a blood transfusion.

When compared to non-Hispanic White patients, Black and Hispanic patients had an adjusted odds ratio (aOR) of 1.77 for blood transfusion. Bleeding disorders had an aOR of 3.38, ASA class 3 or 4 an aOR of 1.47, and preoperative anemia an aOR of 3.20.¹

Specimen weight over 250 g or at least 5 intramural myomas and operation time of 197 minutes or longer were also independently associated with increased risks of blood transfusion, with aORs of 1.87 and 4.08, respectively.

When developing a preoperative 4 parameters model, an area under the receiver operating characteristic curve (AUC) of 0.69 was reported. A pre- and intraoperative 6 parameters model had an AUC of 0.78.

These resultshighlighted preoperative and intraoperative risk factors for blood transfusion among women receiving laparoscopic myomectomies. Investigators recommended further studies to validate these tools and determine how to optimize their use in clinical practice.¹

References

1. Hamilton KM, Liao C, Levin G, et al. Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study. Am J Obstet Gynecol. 2024;231:109.e1-9. doi:10.1016/j.ajog.2024.02.010
2. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7. doi:10.1067/mob.2003.99