Women with anemia at greater risk of complications after elective hysterectomy or fibroid removal
Nearly one in four women who undergo an elective hysterectomy or myomectomy for non-cancerous conditions are anemic, which increases their risk of complications like blood transfusion, infection or readmission into hospital, according to a new study by researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.
Hysterectomy is one of the most common surgeries performed worldwide with over 40,000 procedures performed in Canada every year. Myomectomy is a surgical procedure that removes uterine fibroids (non-cancerous growths) without removing the uterus, it is usually performed in women wishing to enhance or preserve future fertility.
“We need to better understand why one in four women arrive anemic on the day of surgery so that we can optimize surgical outcomes. Anemia is easy to diagnose, simple to treat for the majority of iron-deficiency anemia, and untreated anemia has consistently been shown to be associated with adverse outcomes,” says Dr. Ally Murji, lead author of the study, ICES Scholar and gynecologist at Mount Sinai Hospital.
The researchers looked at data for more than 16,000 women in Ontario who underwent elective hysterectomy or myomectomy for benign conditions from 2013 to 2015 and found:
- 23 per cent undergoing elective surgery were anemic (hemoglobin <120g/L) before the surgery.
- The risk of death, post-operative complications and return to hospital within 30-days after surgery was higher in anemic women compared to non-anemic women (41 vs. 36 per cent).
- The risk of transfusion was significantly higher in anemic patients, where for every 12 women with anemia, one received a blood transfusion.
- There was almost a four-fold increase in the probability of transfusion when pre-operative hemoglobin decreased from 130g/L to 100g/L.
- The risk of adverse outcomes increased in women 55 years and older with anemia, who were at even higher risk of transfusion, surgical site infection and return to hospital.
“We were surprised to find that 42 per cent of women scheduled for elective hysterectomy or myomectomy were not tested for anemia 60 days before their surgery. These women with ‘unknown’ anemia status were at increased risk of perioperative transfusion compared to women who were tested and found not to be anemic pre-operatively,” says Dr. Lorraine Lipscombe, senior author on the study, adjunct scientist at ICES, scientist at Women’s College Research Institute and director, division of endocrinology at Women’s College Hospital.
The researchers say surgeons should ensure that their patients have been tested for anemia since medical interventions exist to correct anemia prior to these gynecological procedures in order to improve outcomes and reduce complications.
Author block: Ally Murji, Melody Lam, Britney Allen, Lucie Richard, Salimah Z. Shariff, Peter C. Austin, Jeannie Callum, Lorraine Lipscombe.
The study “Risks of preoperative anemia in women undergoing elective hysterectomy and myomectomy,” was published in the American Journal of Obstetrics & Gynecology.
For more information, please contact:
Media Advisor, ICES
(o) 416-480-4780 or (c) 647-406-5996
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
Women’s College Hospital (WCH) is a leader in health for women, health equity and health system solutions – a hospital designed to keep people out of the hospital. Guided by our strategic plan, Healthcare Revolutionized 2018-2022, we are setting a new pace for radical redesign in our health system, anchored by our bold vision to revolutionize healthcare for a healthier more equitable world. We are developing groundbreaking innovations that address the most pressing issues related to population health, patient experience and system costs. We advocate for health equity because we know that a healthy society requires a level playing field where everyone has access to timely, high quality, efficient and compassionate care. We are creating new models of technology-enabled and virtual care to improve access, pioneering health system solutions that drive efficiencies. As an academic hospital, fully affiliated with the University of Toronto, we are leading world-class research and training the healthcare providers of the future.
Mount Sinai Hospital, part of Sinai Health System, is as an internationally recognized 442-bed acute care academic health sciences centre affiliated with the University of Toronto. Clinical strengths include women’s and infants’ health, chronic disease management, specialized cancer care, emergency medicine, and geriatrics. Mount Sinai has been designated with Exemplary Status from Accreditation Canada and every aspect of patient care is anchored in a rigorous quality plan and monitoring of safety and quality goals. Mount Sinai is the first hospital in Canada to receive Magnet® status for nursing excellence and patient care. The Hospital is considered to be a top employer in Canada, receiving multiple awards for its employment and culture centred programs. www.mountsinai.ca.
The Dalla Lana School of Public Health is a Faculty of the University of Toronto that originated as one of the Schools of Hygiene begun by the Rockefeller Foundation in 1927. The School went through a dramatic renaissance after the 2003 SARS crisis and it is now the largest public health school in Canada, with more than 850 faculty, 1,000 students, and research and training partnerships with institutions throughout Toronto and the world. With $35.9 million in research funding per year, the School supports discovery in global health, tobacco impacts on health, occupational disease and disability, air pollution, inner city and Indigenous health, among many other areas. For more information, visit us at dlsph.utoronto.ca.