Clinical Benefit of Routine Postoperative Hemoglobin Testing After Vaginal Hysterectomy and Reconstruction for Symptomatic Pelvic Organ Prolapse

Abstract

Objectives:The objective of this study was to determine the clinical benefit of a routine complete blood count (CBC) on the first postoperative day after vaginal hysterectomy with reconstruction.Methods: This retrospective cohort study evaluated patients undergoing vaginal hysterectomy with native tissue prolapse repair between 2014 and 2019. Baseline and operative data, preoperative and postoperative blood counts, signs of anemia, and complications were recorded. Objective signs of anemia included tachycardia, hypotension, and low urine output. Subjective signs of anemia included dizziness, weakness, pallor, and diaphoresis. Complications, such as blood transfusions, additional testing, and readmission, were recorded.Results: Five hundred and seventy patients had a postoperative CBC. The median preoperative hemoglobin level was 13.5 g/dL (min, 9.4; max, 16.9). Ninety-seven (17%) patients had a postoperative hemoglobin of 10 g/dL or less, with a median hemoglobin of 11.2 g/dL (min, 5.6; max, 14.9). Signs of anemia occurred in 72 (12.6%) patients: 64 (11.2%) showing objective signs, 13 (2.3%) reporting subjective symptoms, and 5 (0.8%) noting both. The most common objective sign was hypotension (n = 40; 63.5%). Five women received transfusions (0.9%). All patients receiving a blood transfusion showed objective signs of anemia; 3 (50%) patients had objective and subjective signs. Twenty-one (3.7%) patients had more than 1 CBC test during admission; 9 (42.9%) of these women were asymptomatic and had no further intervention. There were no readmissions related to postoperative anemia. Conclusions:Patients that require intervention for anemia after vaginal hysterectomy and reconstruction will manifest clinical signs or symptoms. Routine CBC testing in this cohort did not provide benefit and led to superfluous procedures in the vast majority of participants.