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Transfusion Rates and the Utility of Type and Screen for Pelvic Organ Prolapse Surgery

Brueseke, Taylor J. MD*; Wilkins, Maggie F. NP*; Willis-Gray, Marcella G. MD*; Husk, Katherine E. MD*; Peedin, Alexis R. MD; Geller, Elizabeth J. MD*; Wu, Jennifer M. MD, MPH*

Female Pelvic Medicine & Reconstructive Surgery: April 20, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000589
Original Article: PDF Only
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Objectives Limited data exist directly comparing the likelihood of blood transfusion by route of apical pelvic organ prolapse (POP) surgery. In addition, limited evidence is available regarding the risk of not ordering preoperative type and screen (T&S) in apical POP surgery. The objectives of the study are to (1) provide baseline data regarding the current need for preoperative T&S by comparing perioperative blood transfusion rates between 3 routes of apical POP surgery and (2) determine the rate of a positive preoperative antibody screen in women who underwent apical POP surgery.

Methods This was a retrospective cohort study of women who underwent apical POP surgery by 3 different routes: abdominal (abdominal sacrocolpopexy), robotic (robotic sacrocolpopexy), or vaginal (uterosacral or sacrospinous ligament fixation).

Results Among 610 women who underwent apical POP surgeries between May 2005 and May 2016, 24 women (3.9%) received a perioperative blood transfusion. The rate of transfusion was higher in the abdominal group (11.1%) compared with robotic (0.5%, P < 0.001) and vaginal (0.5%, P < 0.001). In a logistic regression model, abdominal route of POP surgery remained significantly associated with transfusion (odds ratio, 20.7; 95% confidence interval, 2.7–156.6). Among the 572 women who had a preoperative T&S performed, 9 (1.5%) had a positive antibody screen.

Conclusions Blood transfusion was significantly more common in abdominal compared with robotic and vaginal apical POP surgeries. The rate of a positive antibody screen was low, suggesting that type O blood is low risk if cross-matched blood is not available. Thus, it may be reasonable to not order a preoperative T&S prior to robotic or vaginal apical POP surgery.

From the *Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics/Gynecology, and †Division of Transfusion Medicine, Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Correspondence: Taylor J. Brueseke, MD, University of California, Irvine, 333 City Blvd West, Suite 1400, Orange, CA 92868. E-mail: tbruesek@uci.edu.

The authors have declared they have no conflicts of interest.

This work was presented as an oral poster at the Society of Gynecologic Surgeons Annual Scientific Meeting; San Antonio, TX; March 29, 2017.

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