Hysterectomy and Peri-operative Blood Transfusion: Identifying Modifiable Risk Factors [31H] : Obstetrics & Gynecology

Secondary Logo

Journal Logo

Sunday, May 7, 2017: 1: 00 PM–2: 00 PM: BLUE RIBBON

Hysterectomy and Peri-operative Blood Transfusion: Identifying Modifiable Risk Factors [31H]

Zitsman, Sarah DO, MPH; Yu, Daohai PhD; Bruce, Shaina F. MD; Ramirez-Caban, Laura MD; Diaz, Juan MD

Author Information
Obstetrics & Gynecology 129(5):p 90S, May 2017. | DOI: 10.1097/01.AOG.0000514933.34242.2a



Blood loss and subsequent blood transfusion is a common complication in benign gynecologic surgery that has been understudied. The purpose of this study is to identify risk factors associated with peri-operative blood transfusion and highlight those that are modifiable for abdominal and vaginal hysterectomy.


Using a retrospective study design between 1/1/2008 and 4/30/2014, 562 of 667 hysterectomies were included. Hysterectomies performed peripartum or for cancer were excluded. Risk factors examined include race, pre-operative hemoglobin, body mass index (BMI), surgical route, and uterine size. Comparisons between subgroups were performed using Chi-square or Wilcoxon test. Blood transfusion rate, odds ratio (OR) of transfusion and its 95% confidence interval (CI) were reported. Multiple logistic regression was used to identify potential risk factors for peri-operative blood transfusion.


The overall transfusion rate was 13.3% (75/562) and differed for abdominal versus vaginal hysterectomy (18.0% vs. 6.8% P < .001). Pre-operative hemoglobin less than 10.6 g/dL versus greater than or equal to 13.1 g/dL had five times the odds of transfusion (95% CI 2.4-13.5). Uterus size greater than 470 gm versus less than or equal to 108 gm had fourfold odds of transfusion (95% CI 1.5-14.3). African Americans had twice the odds of transfusion (95% CI 1.2-4.5), despite controlling for increased uterus size and lower hemoglobin. There was no statistically significant association between BMI and transfusion.


This study identified lower pre-operative hemoglobin, larger uterus size, and African American race as three important risk factors. Prior to hysterectomy, hemoglobin should be optimized above 13.1 g/dL, especially for patients with large uteri and African Americans.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Full Text Access for Subscribers:

You can read the full text of this article if you:

Access through Ovid