Ashmore Sarah, Shi Jinxuan, Collins Sarah
Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL, USA.
Int Urogynecol J. 2025 May;36(5):1067-1075. doi: 10.1007/s00192-025-06113-1. Epub 2025 Apr 1.
Routine preoperative laboratory testing is commonly required prior to minimally invasive hysterectomy (MIH) for pelvic organ prolapse (POP), despite limited evidence for its clinical value. We aim to identify transfusion risk for MIH for POP compared with other benign indications.
Using the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program Gynecology Participant Use Data File, we performed a retrospective cohort study to determine the risk of perioperative blood transfusion following MIH for benign indications. MIH were identified using CPT codes, and surgical indications were classified according to ICD-9 and -10 codes. Gynecological malignancy risk-reducing indications were categorized as prophylactic. Hysterectomy routes included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy, and vaginal hysterectomy. Hysterectomies for malignancy were excluded. Perioperative transfusions were defined as those given intraoperatively or within 30 days postoperatively.
A total of 282,124 patients underwent MIH for benign gynecological indications. Patients undergoing MIH for POP compared with other benign indications were older, had lower BMI, and were less likely to currently smoke (p < 0.001). Overall transfusion rate for benign MIH was 1.2%, and transfusion rates differed significantly by surgical indication (p < 0.001). Patients undergoing MIH for POP had a low rate of transfusion (0.7%) compared with other benign indications such as anemia (15.9%), fibroids (1.8%), and menstrual disorders (1.5%).
Patients undergoing surgery for POP had significantly lower rates of transfusion than those with other benign indications. Aggressive preoperative precautions, including laboratory testing and redundant intravenous access, are likely excessive in this population.
尽管微创子宫切除术（MIH）用于治疗盆腔器官脱垂（POP）时，常规术前实验室检查的临床价值证据有限，但通常仍需进行此项检查。我们旨在确定与其他良性指征相比，MIH治疗POP的输血风险。
利用2014年至2021年美国外科医师学会国家外科质量改进计划妇科参与者使用数据文件，我们进行了一项回顾性队列研究，以确定良性指征的MIH术后围手术期输血风险。通过CPT编码识别MIH，并根据ICD-9和-10编码对手术指征进行分类。降低妇科恶性肿瘤风险的指征归类为预防性。子宫切除途径包括全腹腔镜子宫切除术、腹腔镜次全子宫切除术、腹腔镜辅助阴道子宫切除术和阴道子宫切除术。排除恶性肿瘤子宫切除术。围手术期输血定义为术中或术后30天内输血。
共有282,124例患者因良性妇科指征接受MIH。与其他良性指征相比，因POP接受MIH的患者年龄更大，BMI更低，当前吸烟的可能性更小（p < 0.001）。良性MIH的总体输血率为1.2%，输血率因手术指征而异（p < 0.001）。与其他良性指征如贫血（15.9%）、子宫肌瘤（1.8%）和月经紊乱（1.5%）相比，因POP接受MIH的患者输血率较低（0.7%）。
因POP接受手术的患者输血率明显低于其他良性指征患者。在这一人群中，积极的术前预防措施，包括实验室检查和多余的静脉通路，可能是过度的。
