Available online 2 November 2022

To determine the association between preoperative hematocrit and risk of blood transfusion for laparotomic and laparoscopic myomectomy based on fibroid burden and surgical route.

A cohort study of prospectively collected data.

American College of Surgeons National Surgical Quality Improvement Program participating institutions.

26,229 women who underwent a laparotomic or laparoscopic myomectomy from 2010 – 2020.

The primary outcome assessed was the risk of transfusion based on preoperative hematocrit. This was evaluated with respect to fibroid burden and surgical route.

There were 26,229 women who underwent a myomectomy during the study interval, 2345 (9%) of whom required a blood transfusion. Compared with patients who did not require transfusion, those who did had lower median preoperative hematocrit levels (34.7 vs. 38.2). Patients were stratified by surgical approach (laparotomic vs laparoscopic) and fibroid burden (1-4 myomas/weight ≤250g or ≥5 myomas/weight >250g) using CPT codes (58140, 58146, 58545, 58546). In all categories, there was an inverse relationship between blood transfusion and preoperative hematocrit level with increasing risk depending on preoperative hematocrit range. The odds ratios [95% confidence interval] comparing hematocrit level of 29% to 39% were 6.16 [5.15-7.36], 4.92 [4.19-5.78], 4.85 [3.72-6.33], and 5.2 [3.63-7.43] for patients with laparotomic (1-4 myomas/≤250g, ≥5 myomas/>250g) and laparoscopic myomectomy (1-4 myomas/≤250g, 5 myomas/>250g), respectively.

Incremental increases in hematocrit result in a significantly decreased risk of blood transfusion at the time of myomectomy.

gynecologic surgery

laparoscopic myomectomy

laparotomic myomectomy

preoperative anemia

surgical complications

© 2022 Published by Elsevier Inc. on behalf of AAGL.