Assessment of Perioperative Transfusion Risk for Benign Minimally Invasive Hysterectomy Utilizing the ACS-NSQIP

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.