New risk stratification tool helps predict blood transfusion needs in women with uterine fibroids: Study

A recent study published in the American Journal of Obstetrics and Gynecology developed a novel risk stratification tool to predict the need for blood transfusions in women undergoing laparoscopic myomectomy. Uterine fibroids are the most common benign tumors affecting females and often necessitates surgical intervention. Laparoscopic myomectomy is the standard surgical treatment for women wishing to retain their uterus. But, one of the most prevalent complications of this surgery is excessive bleeding.

And so, this study by Kacey Hamilton and team set out to identify the risk factors for intraoperative and postoperative blood transfusions during laparoscopic myomectomies and to develop a risk stratification tool for determining the risk of requiring a blood transfusion. This retrospective cohort research utilized data from the American College of Surgeons National Surgical Quality Improvement Program database by covering the period from 2012 to 2020.

The women who underwent conventional or robotic laparoscopic myomectomy were included in the study. The individuals who received one or more blood transfusions within 72 hours after the surgery were compared with the women who did not require transfusions. Of the 11,498 women who underwent laparoscopic myomectomy during the study period, 331 (2.9%) required a blood transfusion. The multivariable regression analysis revealed several significant preoperative risk factors like, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, a high classification in the American Society of Anesthesiologists (ASA) class III or IV, and a preoperative hematocrit value of ≤35.0%. Also, intraoperative factors contributing to the risk of transfusion included specimen weight exceeding 250 grams, the presence of five or more intramural myomas and an operation time of 197 minutes or more.

The newly developed risk stratification tool assigns points based on the identified risk factors. By summing these points, physicians can calculate the mean probability of a patient requiring a transfusion. This tool holds significant potential for enhancing preoperative planning and patient counseling, ultimately improving surgical outcomes and patient safety.

Overall, the identification of independent risk factors for blood transfusion in women undergoing laparoscopic myomectomy represents a significant advancement in gynecological surgery. Future studies are imperative to validate this tool across diverse populations and surgical settings to ensure its broad applicability and reliability. 

Source:

Hamilton, K. M., Liao, C., Levin, G., Barnajian, M., Nasseri, Y., Bresee, C., Truong, M. D., Wright, K. N., Siedhoff, M. T., & Meyer, R. (2024). Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study. In American Journal of Obstetrics and Gynecology (Vol. 231, Issue 1, p. 109.e1-109.e9). Elsevier BV. https://doi.org/10.1016/j.ajog.2024.02.010