{"id":14027,"date":"2019-07-01T13:07:53","date_gmt":"2019-07-01T13:07:53","guid":{"rendered":"https:\/\/staging.awgp.pt\/testes\/?p=14027"},"modified":"2025-04-22T15:27:24","modified_gmt":"2025-04-22T15:27:24","slug":"risks-of-pre-operative-anemia-in-women-undergoing-elective-hysterectomy-and-myomectomy","status":"publish","type":"post","link":"https:\/\/staging.awgp.pt\/testes\/risks-of-pre-operative-anemia-in-women-undergoing-elective-hysterectomy-and-myomectomy\/","title":{"rendered":"Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy"},"content":{"rendered":"<style type=\"text\/css\"><\/style>[cmsmasters_row data_width=&#8221;boxed&#8221; data_padding_left=&#8221;3&#8243; data_padding_right=&#8221;3&#8243; data_top_style=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_color=&#8221;default&#8221; data_bg_position=&#8221;top center&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_size=&#8221;cover&#8221; data_bg_parallax_ratio=&#8221;0.5&#8243; data_padding_top=&#8221;0&#8243; data_padding_bottom=&#8221;50&#8243;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;]<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31310749\">Am J Obstet Gynecol.<\/a>\u00a02019 Jul 13. pii: S0002-9378(19)30902-0. doi: 10.1016\/j.ajog.2019.07.018. [Epub ahead of print]<\/p>\n<h2>Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy<\/h2>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Murji%20A%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Murji A<\/a><sup>1<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Lam%20M%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Lam M<\/a><sup>2<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Allen%20B%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Allen B<\/a><sup>2<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Richard%20L%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Richard L<\/a><sup>2<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Shariff%20SZ%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Shariff SZ<\/a><sup>2<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Austin%20PC%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Austin PC<\/a><sup>3<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Callum%20J%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Callum J<\/a><sup>4<\/sup>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Lipscombe%20L%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=31310749\">Lipscombe L<\/a><sup>5<\/sup>.<\/p>\n<p><sup>1 Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: ally.murji@sinaihealthsystem.ca.<\/sup><\/p>\n<p><sup>2 ICES Western, London, Ontario, Canada.<\/sup><\/p>\n<p><sup>3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES Toronto, Toronto, Ontario, Canada.<\/sup><\/p>\n<p><sup>4 Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.<\/sup><\/p>\n<p><sup>5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES Toronto, Toronto, Ontario, Canada; Department of Medicine,\u00a0Women&#8217;s College Hospital, Toronto, Ontario, Canada.<\/sup><\/p>\n<h3><\/h3>\n<h3>Abstract<\/h3>\n<p><strong>BACKGROUND<\/strong>: Hysterectomy is one of the most common surgeries performed worldwide. Identification of modifiable risk factors for complications or re-admissions could lead to targeted interventions to improve patient care and reduce healthcare costs. Pre-operative anemia has been identified as a risk factor for adverse post-operative outcomes following non-cardiac surgery. However, studies have not focused on young and healthy surgical populations, such as women undergoing gynecologic surgery for benign indications.<\/p>\n<p><strong>OBJECTIVE(S)<\/strong>: The purpose of this study was to evaluate if pre-operative anemia in women undergoing elective hysterectomy or myomectomy for benign indications was associated with increased 30-day post-operative morbidity and mortality.<\/p>\n<p><strong>STUDY DESIGN<\/strong>: In this retrospective population-based cohort study, we followed adult\u00a0women\u00a0(\u226518 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic\/laparotomy) between the years 2013 and 2015 for benign indications in Ontario, Canada. We used linked administrative data from a government administered single-payer provincial healthcare system using Canadian Classification of Health Interventions (CCI) intervention codes, International Classification of Diseases 10<sup>th<\/sup> Revision (ICD-10) diagnostic codes, physician billing codes and laboratory data from both community and hospital laboratories across the province. Our exposure of interest was pre-operative\u00a0anemia, defined as a hemoglobin value &lt;12g\/dL on the complete blood count measured closest to the date of surgery. Our primary outcome was the composite of 30 day post-operative morbidity and mortality. Secondary outcomes, were five individual components of the primary outcome: death, transfusion, surgical site infection, veno-thromboembolism, and return to hospital within 30 days. To adjust for confounding, we generated a propensity score using a multiple logistic regression model in which the presence of\u00a0anemia\u00a0was regressed on all baseline characteristics. We matched anemic to non-anemic patients on the logit of the propensity score. Using an unadjusted log-binomial model estimated using generalized estimating equations (GEE) to account for the matched pairs, we calculated the relative risk (RR), 95% confidence intervals (CI) and p-values to evaluate the effect of\u00a0anemia\u00a0on outcomes.<\/p>\n<p><strong>RESULTS<\/strong>: Of the 16,218 women in the cohort, 3,664 (22.6%) had anemia. After propensity matching, standardized differences in all baseline characteristics (N=3,261 per group) were &lt;0.10. In the matched cohort, the primary outcome (death, complications, or re-admission) occurred in 41.2% of anemic patients and 36.2% of non-anemic patients (RR 1.14, 95%CI 1.07 &#8211; 1.21, p&lt;0.0001; absolute risk reduction (ARR) 5.03%, 95%CI 2.70 &#8211; 7.36; number needed to harm (NNH)=20). The risk of transfusion was significantly higher in anemic patients (RR 3.25 95%CI 2.67 &#8211; 3.95, p&lt;0.0001; ARR 8.34%, 95%CI 7.06 &#8211; 9.63; NNH=12). There was no difference in other secondary outcomes. In a subgroup analysis (women &gt;55 years versus \u226455, N=736), older women were at increased risk of the primary outcome (RR 1.40, 95%CI 1.12-1.76, p=0.004), transfusion (RR 4.20, 95%CI 1.65-10.72, p=0.003), surgical site infection (RR 1.35, 95%CI 1.01-1.81, p=0.04), and return to hospital (RR 2.36, 95%CI 1.54-3.62, p&lt;0.0001).<\/p>\n<p><strong>CONCLUSION(S):<\/strong> Pre-operative\u00a0anemia\u00a0in\u00a0women\u00a0undergoing elective hysterectomy\/ myomectomy was common and is an independent risk factor for 30-day post-operative adverse outcomes, especially in older\u00a0women.<\/p>\n<p>[\/cmsmasters_text][cmsmasters_button button_type=&#8221;regular&#8221; button_link=&#8221;https:\/\/www.ajog.org\/article\/S0002-9378(19)30902-0\/fulltext&#8221; button_target=&#8221;blank&#8221; button_text_align=&#8221;left&#8221; button_style=&#8221;cmsmasters_but_bg_slide_left&#8221; button_font_weight=&#8221;normal&#8221; button_font_style=&#8221;normal&#8221; button_border_style=&#8221;solid&#8221; animation_delay=&#8221;0&#8243;]Am J Obstet Gynecol[\/cmsmasters_button][\/cmsmasters_column][\/cmsmasters_row]\n","protected":false},"excerpt":{"rendered":"<p>[cmsmasters_row data_width=&#8221;boxed&#8221; data_padding_left=&#8221;3&#8243; data_padding_right=&#8221;3&#8243; data_top_style=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_color=&#8221;default&#8221; data_bg_position=&#8221;top center&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_size=&#8221;cover&#8221; data_bg_parallax_ratio=&#8221;0.5&#8243; data_padding_top=&#8221;0&#8243; data_padding_bottom=&#8221;50&#8243;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;] Am J Obstet Gynecol.\u00a02019 Jul 13. pii: S0002-9378(19)30902-0. doi: 10.1016\/j.ajog.2019.07.018. [Epub ahead of print] Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy Murji A1,\u00a0Lam M2,\u00a0Allen B2,\u00a0Richard L2,\u00a0Shariff SZ2,\u00a0Austin PC3,\u00a0Callum J4,\u00a0Lipscombe L5. 1 Department of Obstetrics&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[96,97],"tags":[92,100,105],"class_list":["post-14027","post","type-post","status-publish","format-standard","hentry","category-anemia-mulher","category-artigo-cientifico","tag-anemia-na-mulher","tag-deficiencia-de-ferro","tag-iron-deficiency"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy - AWGP - Testes<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Risks of pre-operative anemia in women undergoing elective hysterectomy and myomectomy - AWGP - Testes\" \/>\n<meta property=\"og:description\" content=\"[cmsmasters_row data_width=&#8221;boxed&#8221; data_padding_left=&#8221;3&#8243; data_padding_right=&#8221;3&#8243; data_top_style=&#8221;default&#8221; data_bot_style=&#8221;default&#8221; data_color=&#8221;default&#8221; data_bg_position=&#8221;top center&#8221; data_bg_repeat=&#8221;no-repeat&#8221; data_bg_attachment=&#8221;scroll&#8221; data_bg_size=&#8221;cover&#8221; data_bg_parallax_ratio=&#8221;0.5&#8243; data_padding_top=&#8221;0&#8243; data_padding_bottom=&#8221;50&#8243;][cmsmasters_column data_width=&#8221;1\/1&#8243;][cmsmasters_text animation_delay=&#8221;0&#8243;] Am J Obstet Gynecol.\u00a02019 Jul 13. pii: S0002-9378(19)30902-0. doi: 10.1016\/j.ajog.2019.07.018. 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