Department of Obstetrics and Gynecology, Main Line Health (Dr. Klebanoff), Wynnewood, Pennsylvania.
Department of Obstetrics and Gynecology (Drs. Marfori, Barnes, and Moawad).
J Minim Invasive Gynecol. 2021 Oct;28(10):1765-1773.e1. doi: 10.1016/j.jmig.2021.03.007. Epub 2021 Mar 18.
We sought to identify the variables independently associated with intra/postoperative blood transfusion at the time of myomectomy. We further hoped to develop an accurate prediction model using preoperative variables to categorize an individual's risk of blood transfusion during myomectomy.
Case-control study.
Not applicable to this study, which used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
Women who underwent an open/abdominal or laparoscopic (robotic or conventional) myomectomy between 2014 and 2017 at participating ACS-NSQIP sites.
The primary dependent variable was occurrence of intra/postoperative bleeding requiring blood transfusion. Patient demographics, clinical characteristics, preoperative comorbidities, intraoperative variables, and additional 30-day postoperative outcomes were compared at the bivariable level. For the prediction-model development, only variables that can be reasonably known before surgery were included. Variables associated with intra/postoperative bleeding were entered into 2 separate multivariable logistic regression models. Validation of our prediction model was performed internally using 250 bootstrapped iterations of 50% subsamples drawn from the overall population of myomectomy cases from the ACS-NSQIP database.
We identified 6387 myomectomies performed during the defined study period. The most common race in our population was black/African American (45.7%), and most of the patients (57.5%) received an open/abdominal route of myomectomy. A total of 623 patients who underwent myomectomy (9.8%) experienced intraoperative/postoperative bleeding with a need for blood transfusion. At the bivariable level, we identified several variables independently associated with the need for blood transfusion at the time of myomectomy. In using only those variables that can be reasonably known before surgery to develop our prediction model, additional multivariable logistic regression elucidated black race, need for preoperative blood transfusion, planned abdominal/open route of surgery, and preoperative hematocrit value as independently associated with blood transfusion.
We identified a number of perioperative variables associated with intraoperative or postoperative bleeding requiring blood transfusion at the time of myomectomy. We subsequently created a model that accurately predicts individual bleeding risk from myomectomy, using variables that are reasonably apparent preoperatively. Making this prediction model clinically available to gynecologic surgeons will serve to improve the care of women undergoing myomectomy.
我们旨在确定子宫肌瘤剔除术时与术中/术后输血相关的独立变量。我们希望进一步使用术前变量开发一个准确的预测模型，以对个体在子宫肌瘤剔除术中输血的风险进行分类。
病例对照研究。
本研究不适用，因为使用了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库。
2014 年至 2017 年期间在参与 ACS-NSQIP 地点接受开放/腹部或腹腔镜（机器人或常规）子宫肌瘤剔除术的女性。
主要因变量为术中/术后出血需要输血。在单变量水平上比较患者人口统计学特征、临床特征、术前合并症、术中变量和其他 30 天术后结果。对于预测模型的开发，仅纳入可以在术前合理了解的变量。将与术中/术后出血相关的变量纳入 2 个单独的多变量逻辑回归模型。使用从 ACS-NSQIP 数据库中总体子宫肌瘤剔除术病例中抽取的 250 个 50%子样本的 250 次 bootstrap 迭代，在内部验证我们的预测模型。
我们确定了在定义的研究期间进行的 6387 例子宫肌瘤剔除术。我们人群中最常见的种族是黑人/非裔美国人（45.7%），大多数患者（57.5%）接受了开放/腹部途径的子宫肌瘤剔除术。共有 623 例接受子宫肌瘤剔除术的患者（9.8%）经历了术中/术后出血，需要输血。在单变量水平上，我们确定了一些与子宫肌瘤剔除术时输血需求相关的独立变量。在使用只能在术前合理了解的变量来开发我们的预测模型时，额外的多变量逻辑回归阐明了黑种人、术前需要输血、计划的腹部/开放手术途径和术前红细胞压积值与输血相关。
我们确定了一些与子宫肌瘤剔除术时术中或术后出血需要输血相关的围手术期变量。随后，我们使用术前明显的变量创建了一个准确预测个体子宫肌瘤剔除术出血风险的模型。使这个预测模型在妇科医生中得到临床应用，将有助于改善接受子宫肌瘤剔除术的女性的护理。
