Analysis of the incidence and risk factors of blood transfusion in robot-assisted laparoscopic total hysterectomy: a retrospective nationwide inpatient sample database study.

OBJECTIVE: This study sought to determine the incidence and risk factors associated with blood transfusion among patients undergoing robot-assisted laparoscopic total hysterectomy (RA-TLH), using a nationwide database.

METHODS: A retrospective data analysis was conducted using the Nationwide Inpatient Sample (NIS), which enrolled patients who underwent RA-TLH from 2010 to 2019, with complete demographic and clinical information available. Patients were categorized into two groups based on whether they had received blood transfusions. Comparisons were made regarding demographic data, length of hospital stay (LOS), total hospital charges (TOTCHG), hospital characteristics, mortality rates, comorbidities, and perioperative complications. Univariate and multivariate logistic regression analyses were then conducted to identify factors independently associated with transfusion in RA-TLH patients.

RESULTS: From 2010 to 2019, 3.47% of patients undergoing RA-TLH received blood transfusions. Patients who received transfusions experienced extended hospital stays, increased total hospital costs, elevated mortality during hospitalization, and were more commonly managed at teaching hospitals and medical centers in the southern region, or a higher proportion were of Black ethnicity. Besides, patients relying on self-pay experienced a higher rate of transfusion (P < 0.05). Several comorbidities were associated with increased risk of transfusion: congestive heart failure(OR 1.60; 95%CI: 1.21-2.13),coagulopathy(OR 5.27;95%CI: 4.08-6.82),fluid and electrolyte disorders(OR 2.30; 95%CI: 1.91-2.76),metastatic cancer (OR 1.83; 95%CI: 1.40-2.40), pulmonary circulation disorders (OR 1.75; 95%CI: 1.16-2.63), renal failure(OR 1.85;95%CI: 1.43-2.38),weight loss(OR 2.39; 95%CI: 1.68-3.43), and anemia. Age was not identified as a risk factor for transfusion. Blood transfusion was significantly associated with elevated rates of postoperative complications, including sepsis, acute myocardial infarction, cardiac arrest, and shock (P < 0.05), in addition to deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, hemorrhage/seroma/hematoma, genitourinary disease, pulmonary embolism, and conversion to an open procedure.

CONCLUSIONS: In conclusion, this study reports a 3.47% incidence of transfusion in RA-TLH and identifies high-risk patient profiles based on race, insurance status, and specific comorbidities. Furthermore, transfusion was independently associated with significantly poorer outcomes, including longer LOS, increased inpatient charges, and higher hospital mortality. These findings provide critical data for preoperative optimization, enhancing risk stratification, patient counseling, and the development of targeted blood management strategies to prevent adverse events.