Routine hematocrit after elective gynecologic surgery

Kohli, Neeraj; Mallipeddi, Padma; Neff, Judy M.; Sze, Eddie H.M.; Roat, Todd W.

doi:10.1016/s0029-7844(00)00796-1

Cited by 16 publications

(5 citation statements)

References 9 publications

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“…In a study of women undergoing elective gynecologic surgery, the overall incidence of blood transfusion was 1.9%, with none of these transfusions triggered specifically based on the postoperative hematocrit value. 14 A more recent study of women undergoing total laparoscopic hysterectomy found routine postoperative hemoglobin testing to be of little clinical benefit in the absence of clinical signs and symptoms of anemia and that results did not guide clinical care. 15 …”

Section: Discussionmentioning

confidence: 99%

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

Burnett

Junn

Kolenic

et al. 2016

Journal of Gynecologic Surgery

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Background: Laboratory blood testing incurs financial costs and the blood draws can increase discomfort, yet minimal data exists regarding routine testing in gynecologic oncology surgical patients. Additionally, an increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. An increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. Objective: The aims of this study were (1) to evaluate the frequency and etiology of perioperative laboratory test abnormalities in patients undergoing laparoscopic and laparotomy surgery in a gynecologic oncology service, and (2) to establish an evidence-based algorithm to reduce unnecessary laboratory testing. Materials and Methods: A single-institution retrospective study was completed, investigating laparoscopic and laparotomic surgeries over 4 years. Information on preoperative and postoperative laboratory data, surgical parameters, perioperative interventions, and patient demographics was collected. Quality-assurance data were reviewed. Data were tabulated and analyzed using Statistical Product and Service Solutions (SPSS) version 22. A Student's t-test was used to test for group differences for continuous variables with equal variance, the Mann-Whitney–U test for continuous variables when unequal variance was detected, and Pearson's χ2 was used to investigate categorical variables of interest. p-Values <0.05 were considered to be statistically significant. Logistic regression was performed to investigate the relationships among multiple predictors and each identified outcome. Results: The study included 481 subjects (168 laparoscopies, 313 laparotomies). Patients undergoing laparoscopy were, on average, younger (53.5 versus 57.4), with lower body mass indexes (29.7 versus 33.0) and lower rates of diabetes (10.7% versus 19.5%), compared to patients undergoing laparotomy. Overall, >98% of patients underwent at least one preoperative and postoperative laboratory test, totaling 8060 preoperative and 5784 postoperative results. The laparoscopy group was significantly less likely to have postoperative metabolic abnormalities or to undergo perioperative blood transfusion. Patients taking an angiotensin-converting-enzyme inhibitor, angiotensin-II–receptor blocker, or diuretic were significantly more likely to have elevated creatinine preoperatively (odds ratio [OR]: 5.0; p < 0.001) and postoperatively (OR: 7.1; p < 0.001), and this remained true for each group when divided by surgical approach. Perioperative complications meeting institutional quality assurance criteria occurred in 1.7% of laparoscopy patients compared to 11.8% of laparotomy patients (p < 0.001); perioperative laboratory testing was not a factor in the diagnosis of these complications. Conclusions: Clinically signif...

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Section: Discussionmentioning

confidence: 99%

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

Burnett

Junn

Kolenic

et al. 2016

Journal of Gynecologic Surgery

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“…Furthermore, although one unnecessary postoperative hematocrit test might seem innocuous, in actuality it can lead to more costly and more invasive procedures for patients including repeat laboratory testing to validate or refute prior testing, unnecessary imaging studies and radiation exposure, surgical interventions, and delayed hospital discharge. Despite the additional interventions that may be incurred, it has been clearly demonstrated that the practice of routine hematocrit testing after benign gynecologic surgery does not improve outcomes [3,4]. Therefore, use of the present model could help to eliminate the practice of routine postoperative hematocrit testing after uncomplicated hysterectomy for benign indications, thereby promoting both the practice of evidence-based medicine and good stewardship of resources.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, postoperative protocols are largely determined by historical practices and expert opinion rather than by scientific evidence. Although numerous textbooks recommend blood tests—including a complete blood count—as part of the routine postoperative evaluation of a patient, several studies suggest that such routine laboratory testing rarely results in meaningful differences in clinical outcomes [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Predicting postoperative day 1 hematocrit levels after uncomplicated hysterectomy

Swenson

Lanham

Morgan

et al. 2015

Intl J Gynecology & Obste

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Objective To develop a model for predicting postoperative hematocrit levels after uncomplicated hysterectomy. Methods In a retrospective study, data were analyzed from the Michigan Surgery Quality Collaborative for non-emergent hysterectomies performed for benign indications among women aged at least 18 years between January 1, 2012, and April 4, 2014. Linear mixed models were used for univariate and multivariate analyses. Results The model was developed with data from 4747 hysterectomies and validated on 1184 cases. In the mixed multivariate analysis, higher postoperative day 1 (POD1) hematocrit levels were associated with higher weight (B=0.03222, P<0.001), higher preoperative hematocrit (B=0.6587, P<0.001), and non-vaginal hysterectomy (B=0.2815, P=0.0055). Lower POD1 hematocrit was associated with higher preoperative platelet count (B=–0.00457, P<0.001), greater estimated blood loss (B=– 0.00652, P<0.001), and larger intraoperative crystalloid volume (B=–0.3303, P<0.001). The final model predicted POD1 hematocrit within 4% points of the actual value for 91.7% of cases in the validation set. Conclusion Use of the model after uncomplicated hysterectomy might help to support the practice of selectively conducting postoperative hematocrit tests after hysterectomy in a clinically thoughtful and cost-effective manner.

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“…In the present era of capitated reimbursement and continuing limitation of healthcare dollars, medical providers must continually assess the value of routine laboratory testing (1). Although the cost of individual tests might be low, aggregate costs over time are substantial (2). At the same time, studies have suggested that physicians may be overusing laboratory testing owing to legal and other considerations (2).…”

mentioning

confidence: 99%

“…Although the cost of individual tests might be low, aggregate costs over time are substantial (2). At the same time, studies have suggested that physicians may be overusing laboratory testing owing to legal and other considerations (2). In the USA, approximately 2838 000 elective gynecologic operations are performed each year (3).…”

mentioning

confidence: 99%

Urine culture at removal of indwelling catheter after elective gynecologic surgery: is it necessary?

Horowitz¹,

Dekel²,

Yogev³

et al. 2004

Acta Obstet Gynecol Scand

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Routine hematocrit after elective gynecologic surgery

Abstract: Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome.

Cited by 16 publications

References 9 publications

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients

Predicting postoperative day 1 hematocrit levels after uncomplicated hysterectomy

Urine culture at removal of indwelling catheter after elective gynecologic surgery: is it necessary?

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