Clinical Utility of Hemoglobin Testing After Minimally Invasive Sacrocolpopexy

Lavelle, Erin Seifert; Giugale, Lauren E.; Sears, Sarah; Carter-Brooks, Charelle M.; Shepherd, Jonathan

doi:10.1097/spv.0000000000000409

Cited by 5 publications

(10 citation statements)

References 6 publications

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“…Furthermore, 35% underwent concurrent midurethral sling procedures. 2 The median decrease in hemoglobin reported here was 2.2 g/dL, consistent with other reports among this surgical population, 11 and likely related to the increase in dissection along vaginal mucosal surfaces.…”

Section: Discussionsupporting

confidence: 91%

“…In that report, 5% of the sample demonstrated a postoperative hemoglobin level less than 10 g/dL. 2 In contrast, we noted 17% of the women in our study had a POD1 hemoglobin level less than 10 g/dL. This difference may be attributed to the much larger proportion of our patients undergoing hysterectomy at the time of prolapse repair (100% vs 60%), and the fact that the vast majority of our patients had concomitant vaginal native tissue repairs for anterior or posterior compartment prolapse.…”

Section: Discussionmentioning

confidence: 85%

“…In 1 report, 90% of women would not have required POD1 CBC testing if laboratory blood testing was restricted to patients with 2 or more signs of anemia. 2 Others have corroborated that almost all patients that ultimately require blood transfusion will show clinical signs of anemia. 1,3,6 Several risk factors for large decreases in hemoglobin levels on POD1 have been documented in these reports and include hysterectomy at the time of pelvic surgery, midurethral sling placement at the time of prolapse repair, lower body mass index, and increased intravenous (IV) fluids received in the operating room.…”

mentioning

confidence: 99%

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

Aldrich¹,

Pauls²

2021

Female Pelvic Med Reconstr Surg

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 85%

mentioning

confidence: 99%

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

Aldrich¹,

Pauls²

2021

Female Pelvic Med Reconstr Surg

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“…Poor functional status, as defined by a higher ASA seems to be associated with a longer length of hospital stay according to studies by Victory et al 11 and Greer et al 12 A second study by Greer et al 13 found that an ASA class III and history of recent weight loss were risk factors for an increased hospital stay. In addition, lower body mass index (BMI) has been associated with a more drastic hemoglobin drop after minimally invasive ASC 14 …”

Section: Resultsmentioning

confidence: 99%

“…In addition, lower body mass index (BMI) has been associated with a more drastic hemoglobin drop after minimally invasive ASC. 14…”

Section: Preoperative Medical Optimizationmentioning

confidence: 99%

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

Nemirovsky

Herbert

Gorman

et al. 2020

Neurourology and Urodynamics

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Purpose Enhanced recovery after surgery (ERAS) pathways have been shown to reduce surgical morbidity and length of stay across various procedures. Our objective was to systematically evaluate the literature for best practices of ERAS elements in abdominal sacrocolpopexy (ASC), to determine if there is sufficient evidence to create best practice guidelines for this procedure. Materials and Methods Following the preferred reporting items for systematic review and meta‐analysis (PRISMA) statement, we performed a review using Pubmed, Embase, and Cochrane Library. Eligible articles contained ERAS components and postoperative outcomes of ASC published in English since 1997. Thirty‐five full‐text articles were selected for final qualitative analysis. Results Poor functional status before ASC was associated with a longer length of hospital stay. Laparoscopic ASC was associated with a shorter postoperative hospital stay, with no difference between laparoscopic and robotic approaches. Epidural analgesia in addition to spinal anesthesia lowered levels of pain throughout the postoperative stay in laparoscopic ASC. A multimodal bowel regimen shortened time to first bowel movement compared to a single agent regimen. Removing a Foley catheter may lead to sooner first spontaneous void but may result in higher rates of urinary retention and urinary tract infection. Studies investigating preoperative bowel preparation, preanesthesia medication, and multidose antimicrobial prophylaxis did not show significant benefit. Conclusions Best practices for ASC can be developed based on current findings from the literature and extrapolation of evidence from other surgeries where ASC‐specific elements are missing, with the ability to modify the pathways as new data become available.

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Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Deffieux,

Perrouin-Verbe,

Campagne-Loiseau

et al. 2024

European Journal of Obstetrics & Gynecology and Reproductiv

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Clinical Utility of Hemoglobin Testing After Minimally Invasive Sacrocolpopexy

Cited by 5 publications

References 6 publications

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

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

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

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