Transfusion rate associated with hysterectomy for benign disease

Abstract

The transfusion rate associated with hysterectomy for benign disease is an indirect indicator of haemorrhage. It is used in quality assurance activities and is one measure of standard of care. This retrospective study was conducted to determine the transfusion rate for these operations in a tertiary referral hospital. In addition, it was considered that the information could be used in deciding the need for a routine preoperative group and save policy (G and S). The Blood Bank records of all women undergoing hysterectomy for benign disease from 1993-1998 were examined and the number of women transfused was recorded. A total of 1220 hysterectomies were performed. Of women having vaginal hysterectomies only 0.38% required transfusion compared with 2.18% for abdominal hysterectomies. These data suggest that there is no need for a strict policy of preoperative G and S for all patients. In addition, this information can be used as a benchmark when reviewing morbidity associated with hysterectomy and in particular when various methods of hysterectomy are compared.

Transfusion rate and prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease

“…Consistent with previous studies, we found a significantly higher transfusion rate for abdominal hysterectomy compared with vaginal hysterectomy (7 vs. 3%) (1,14). However, for both of these surgical procedures the transfusion rates in our study were higher than previously reported rates with respect to studies published after 1990 (1,9,15–17), where the reported transfusion rates were 0.38–2.4% at vaginal hysterectomy and 2.18–4.7% for abdominal hysterectomy. This discrepancy may be explained by differences in study design but may also reflect the presence of a generally high transfusion rate in Denmark, with a possible overuse of blood components often claimed to be caused by a very liberal transfusion policy.…”

“…Indeed, even when sensitization of transfused red blood cells by antibody is demonstrated in the laboratory, clinical hemolysis is not always present, and even when changes in biochemical parameters indicate the presence of hemolysis, it is not always associated with increased morbidity. Taken together, our data support other studies suggesting that the clinical impact of the preoperative routine ‘type and screen’, with or without a computer cross‐match procedure, is questionable for surgical procedures associated with a very low transfusion rate (1,9,20).…”

“…Previously published data suggest that transfusion rates at hysterectomy have decreased since the early 1980s, thus following a general trend towards a more restrictive transfusion practice in surgery (1–3). Possible reasons for this decreased transfusion rate include awareness of the risk of blood‐borne infections, improved surgical procedures, increased focus on medical expenses, reassessment of transfusion guidelines and increased attention to the inappropriate use of blood transfusions in times of blood supply shortages.…”

Factors associated with the need for blood transfusion during hysterectomy

“…In the present study, more than 1 in 10 patients undergoing hysterectomy required a transfusion. This finding contrasts with previous reports where transfusions ranged between 2.2% [7] and 5% [8] of gynecologic surgeries. A fact that must be considered is that the study hospital is a teaching hospital, and resident physicians who were training in obstetrics and gynecology performed many of the hysterectomies; however, a professor was always present and provided support during surgery if necessary.…”

Morbidity associated with vaginal hysterectomies in Queensland public teaching hospitals

“…In 1990 Brunello 17 documented a series of 62 vaginal hysterectomies. In 2001, Varol 18 published a retrospective analysis of 462 vaginal hysterectomies and Otton 19 published a paper detailing transfusion rates in association with 532 vaginal hysterectomies. Thus there are little sizable and/or contemporary Australian data of adverse outcomes associated with vaginal hysterectomy available.…”