Blood transfusion for radical hysterectomy before and after the discovery of transfusion-related human immunodeficiency virus infection.

Abstract:

OBJECTIVE:To compare the patterns of perioperative blood transfusion in patients undergoing radical hysterectomy in time periods before and after the discovery of transfusion-related human immunodeficiency virus (HIV) infection. METHODS:We reviewed the medical records of all patients who underwent radical hysterectomy and pelvic lymphadenectomy at Memorial Sloan-Kettering Cancer Center during two time periods, an early period (January 1, 1980 through December 31, 1993) and a late period (July 1, 1991 through June 30, 1993). The early period preceded and the late period coincided with the era of increased awareness of transfusion-related HIV infections. RESULTS:One hundred twenty-eight patients underwent radical hysterectomy in the early period and 71 in the late period. In the late period, markedly fewer units of blood were transfused per patient (0.62 versus 3.5). Most patients in the early period received at least one unit (117 of 128, 91%), compared with less than half (31 of 71, 44%) in the late period. For patients who received transfusions, notably fewer received homologous blood during the late (6 of 31, 19%) versus the early period (117 of 117, 100%). Using an unpaired t test and the 95% confidence interval (CI), we found that the patients in the late period had a shorter mean postoperative length of stay (11 versus 14 days, P < .0001, 95% CI +/- 1.3) and were discharged with a significantly lower mean hemoglobin level (9.7 versus 11.4 g/dL, P < .0001, 95% CI +/- 0.35). The mean estimated blood loss was lower in the late period (756 versus 1598 mL). We defined the transfusion index as the number of units transfused per 500 mL of estimated blood loss. The mean transfusion index was significantly lower during the late period (0.38 versus 1.1, P < .001, 95% CI +/- 0.19). CONCLUSIONS:During the perioperative period for radical hysterectomy and pelvic lymphadenectomy, the incidence of blood transfusion at our institution has markedly decreased over the past decade without immediate adverse effects on postoperative recovery. The reasons for this are probably multifactorial. However, the contribution of increased concern about transfusion-related HIV infections must be considered. Preoperative autologous donation can notably decrease the need for homologous transfusion.

journal_name

Obstet Gynecol

authors

Benjamin I,Barakat RR,Curtin JP,Jones WB,Lewis JL Jr,Hoskins WJ

subject

Has Abstract

pub_date

1994-12-01 00:00:00

pages

974-8

issue

6

eissn

0029-7844

issn

1873-233X

journal_volume

84

pub_type

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