Factors associated with Excessive Blood Loss and Blood Transfusion in Abdominal Hysterectomy for Benign Gynecologic Diseases

Abstract

          Background: Hysterectomy is a common major gynecological procedure. Though, it is quite safe for patients, intraoperative hemorrhage was found as the main complication. Objective: To determine the incidence of excessive blood loss (>500 ml) and blood transfusion in abdominal hysterectomy and factors associated with those incidences for benign gynecologic conditions. Patients & Methods: Retrospective descriptive study was conducted in 854 women who underwent total abdominal hysterectomy for benign gynecologic conditions at Maharat Nakhon Ratchasima Hospital between January 2008 to December 2009. Data were collected from patient medical records. Logistic regression analysis was performed to determine the independent factors that were associated with an increasing risk of excessive blood loss and blood transfusion. Results: The median blood loss was 250 ml (range 50-2,500). One hundred and eighty two (21.3%) patients had excessive blood loss. BMI > 25 kg/m², diagnosis of endometriosis or tuboovarian abscess, uterine size >12 weeks, level of surgeon, s skill and pelvic adhesion were factors significantly associated with excessive blood loss. One hundred and three (12.1%) patients had intraoperative blood transfusion. Operative time >120 min, preoperative hemoglobin levels <12 gm/dL and pelvic adhesion were factors significantly related to blood transfusion. One hundred and nineteen (13.9%) patients had preoperative blood transfusion because hemoglobin level at admission was <10 gm/dL. Conclusion: The incidence of excessive blood loss in abdominal hysterectomy in Maharat Nakhon Ratchasima Hospital was 21.3%, intraoperative blood transfusion was 12.1% and pre-operative blood transfusion was 13.9%. The associated factors should be concerned since preoperative period to improve the surgical outcome.