Surgical Indication and Approach are Associated with Transfusion in Hysterectomy for Benign Disease

Objective: To identify pre-operative and intraoperative factors associated with the risk of red blood cell transfu-sion among women undergoing hysterectomy.Methods: A retrospective cohort study of hysterectomy for benign indications between January 1, 2011 - Dec-ember 31, 2017. Patients receiving blood transfusion within 30 days of surgery were compared to patients who did not receive any transfusion. Multivariate logistic regression analysis was performed to identify clinical and surgical variables associated with blood transfusion. Results: Among 171,940 women who underwent hyster-ectomy for benign indication, 4,667 (2.7%) required blood transfusion. The rate of transfusion was highest among patients with uterine fibroids (4.3%) and lowest in patients with genital prolapse (1.1%) (p < 0.05). Odds of blood transfusion were significantly elevated in patients undergoing hysterectomy for uterine fibroids compared to patients with genital prolapse (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.15 - 1.61). Other patient characteristics included body mass index, smoking, bleed-ing disorders, pre-operative sepsis, and American Society of Anesthesiologists score >= 2 (p < 0.05). Higher pre -opera-tive hematocrit significantly decreased the risk of blood transfusion (aOR 0.84, 95% CI 0.84 - 0.85 per percent increase in hematocrit). Abdominal and vaginal hysterecto-mies were associated with greater odds of transfusion com-pared with laparoscopic approaches (aOR 5.06, 95% CI 4.70 - 5.44; aOR 1.87, 95% CI 1.67 - 2.10, respectively).Conclusion(s): Certain patient comorbidities, surgical indication, and approach to hysterectomy are associated with increased risk of blood transfusion. These results may have implications for pre-operative patient counsel-ing, perioperative care, and health system planning.