Design: Prospective single-arm trial, with the intervention period from Apr01/2023 to Jun30/2023. Patient outcomes were compared between the pre-intervention period (Apr01/2021-Mar30/2023) and post-intervention period (Jul01/2023-Jun30/2024).
Setting: Tertiary academic hospital in Ottawa, Ontario, Canada.
Patients or Participants: Patients undergoing hysterectomy for non-cancerous gynecologic condition.
Interventions:
An intervention bundle for pre-operative hemoglobin optimization was developed by a multidisciplinary panel of clinical experts (gynecologic surgeons, hematologists, anesthesiologists, nursing, hospital administration, patient partner). Th included clinical care algorithms, systemic safety processes using electronic medical record functions, and communication strategies with the clinical teams.
Measurements and Main Results:
1305 patients underwent hysterectomy in our study period (904 pre-intervention; 401 post-intervention). Overall, there were 318(24.4%) abdominal, 599(45.9%) laparoscopic, and 388(29.7%) vaginal hysterectomies. Peri-operative transfusion rate was 3.6%, and peri-operative transfusion was associated with pre-operative anemia and abdominal hysterectomy.
Following the study intervention period, there was a substantial decrease in rates of pre-operative anemia (Hb <120g/L) from 19.4% to 16.5%, and rates of iron deficiency (serum ferritin <30mcg/dl) from 31.8% to 28.5%.
This corresponded to a significant improvement in mean pre-operative Hb level (g/L) for all hysterectomies (129.7±15.4 pre-intervention to 132.3±14.4 post-intervention) and for abdominal hysterectomy (125±19 to 131±16 ). There was also significant reduction in peri-operative transfusion rate for all hysterectomies (4.4% to 1.7%) and for abdominal hysterectomy (13.3% to 5.1%). (p<0.05 for above comparisons)
No significant differences were observed for laparoscopic (Hb 131±14 to 133±14; transfusion 1.0% to 1.0%) and vaginal (Hb 132±12 to 133±14; transfusion 1.5% to 0.9%) hysterectomy subgroups, though non-significant trends were observed.
Conclusion: Patients undergoing abdominal hysterectomy for non-cancerous conditions are at risk of pre-operative anemia and perioperative transfusion; and that risk may be substantially decreased with use of minimally invasive approaches and multimodal hemoglobin optimization intervention strategies.
Chen, I*1, Clancy, A2, Touchie, D3, Graham, M4, Duke, K5, Gomes, M1, Prince, A6, Tinmouth, A7, Fergusson, D8, Gagne, S9, Pysyk, C9, Choudhry, AJ10, Khamisa, K7. 1Department of Gynecology and Obstetrics, University of Ottawa, Ottawa, ON, Canada; 2Department of Urogynecology, University of Ottawa, Ottawa, ON, Canada; 3Ontario Transfusion Coordinators Program, Ottawa, ON, Canada; 4The Ottawa Hospital, Ottawa, ON, Canada; 5Surgical Care, The Ottawa Hospital, Ottawa, ON, Canada; 6Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada; 7Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, ON, Canada; 8Department of Medicine, University of Ottawa, Ottawa, ON, Canada; 9Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; 10Ottawa Hospital Research Institute, Ottawa, ON, Canada
