Importance of Estimated Blood Loss in Resource Utilization and Complications of Hysterectomy for Benign Indications

Abstract

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

Role of Intravenous Tranexamic acid (TXA) in reducing perioperative blood loss in hysterectomy for benign gynecological conditions.

“…Adhesive disease, being younger than 40 years of age, having a body mass index greater than 35, and the need for a preoperative transfusion were also statistically significantly associated with estimated blood loss greater than 400 mL. [20] Peipert et al [4] demonstrated that patients with excess blood loss >750 mL had a 3.7-fold increase in febrile morbidity after hysterectomy. Surgery affects the coagulation systems and consequent to the increased release of plasminogen activator inhibitor, the fibrinolytic system shuts down, thus leading to coagulopathy and bleeding.…”

“…[18] Johns et al [19] reviewed 2,563 hysterectomies performed for non-malignant indications, and they concluded that LAVH was safe with similar complication rates as abdominal or vaginal hysterectomy, and was superior to abdominal hysterectomy (AH). English et al (2019) showed that in their study, there were 18,033 hysterectomies for benign indications from 61 hospitals. [20]The median estimated blood loss was 100 mL, and the 90th percentile estimated blood loss was 400 mL.…”

“…English et al (2019) showed that in their study, there were 18,033 hysterectomies for benign indications from 61 hospitals. [20]The median estimated blood loss was 100 mL, and the 90th percentile estimated blood loss was 400 mL. It was shown that there were increased risks of transfusion, readmission, reoperation, length of stay, and major postoperative complications with estimated blood loss greater than 400 mL.…”

Increased Intraoperative Faculty Entrustment and Resident Entrustability Does Not Compromise Patient Outcomes After General Surgery Procedures

“…Due to internal validation, we expect provider involvement information to be reliable and congruent for our historical surgical cohort. [18][19][20][21]…”

“…Qualified nurse abstractors perform appropriate chart abstraction of clinically relevant information regarding surgical cases using a sampling methodology to ensure representativeness of the case mix that have been previously described. [18][19][20][21] The MSQC, due to the sampling methodology and chart abstraction of surgical cases including outcomes information, represented our closest, immediately available ''gold'' standard dataset for the state. We compared the most commonly performed surgeries within the collaborative to our institutional cohort.…”