Pre-Operative Risk Factors of Transfusion during Myomectomy

Study Objective Identify pre-operative risk factors for transfusion during abdominal myomectomy. Design Retrospective cohort study. Setting Academic Medical Center. Patients or Participants Patients undergoing abdominal myomectomy by a single surgeon between 2010 and 2016. Interventions Pre-operative patient characteristic data, intra-operative data, and peri-operative transfusion and blood loss data were collected retrospectively. Prior Pelvic Surgery was defined as myomectomy, cesarean section, and/or endometriosis surgery; Transfusion was defined as intra-operative cell salvage transfusion, intra-operative allogeneic transfusion, and/or post-operative allogeneic transfusion. Composite Blood Loss Morbidity was defined as presence of any transfusion, reoperation after myomectomy, hematocrit nadir ≤21, and/or estimated blood loss (EBL) ≥1000mL. Logistic regression analysis of risk factors for transfusion was performed. Measurements and Main Results 554 patient charts were available for review. Eighty (14.4%) patients underwent transfusion as a result of myomectomy (66 (12%) intra-operative cell salvage, 2 (0.4%) intra-operative allogeneic, and 30 (5.4%) post-operative allogeneic). Women with prior pelvic surgery (OR 3.1), prior myomectomy (OR 2.6), prior endometriosis surgery (OR 5.1), prior UAE (OR 6.3), large uterine size ≥20 weeks (OR 4.8), large fibroid (≥10cm) on MRI (OR 2.1), low preoperative hematocrit 2.3 hours (OR 9.7), or many (≥50) fibroids removed (OR 2.1) had significantly greater odds of having a transfusion (P Conclusion Knowledge of patient risk factors for transfusion as a result of abdominal myomectomy is crucial for patient counseling and peri-operative planning.