Preoperative risk factors for blood transfusion in women requiring surgical management of ectopic pregnancy: a retrospective cohort study

Abstract

Objective This study identifies preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy. A retrospective chart review of 252 cases was performed at a single academic-affiliated community hospital system between January 2014 and October 2017. Univariate analysis was performed using non-parametric testing where appropriate, and significant variables were incorporated in multivariate modelling.Methods In this cohort of 252 women, the overall transfusion rate was 8.7% (n=22). Increasing age (OR 1.12, 95% CI 1.03 to 1.22), lower systolic blood pressure (SBP) on presentation (OR 0.96, 95% CI 0.93 to 1.00), lower minimum systolic and diastolic blood pressure (DBP) (OR 0.92, 95% CI 0.89 to 1.95 and OR 0.9, 95% CI 0.84 to 0.93) and lower preoperative haemoglobin (g/L) (OR 0.46, 95% CI 0.33 to 0.62) were associated with higher rates of blood transfusion. Women who had prior care in their current pregnancy and women treated in a women’s specific emergency room (compared with a general emergency room) were less likely to be transfused (OR 0.16, 95% CI 0.05 to 0.51 and OR 0.09, 95% CI 0.03 to 0.30, respectively). Our study used a model in which variance in transfusion can reliably be explained by location of presentation to care, pain alone as a presenting complaint and haemoglobin level (Area under the curve (AUC) =0.87).Conclusion History of caesarean section and a presenting complaint of pain alone are newly identified indicators for women at higher risk of transfusion at the time of surgical management of ectopic pregnancy. Additionally, care provided in women’s specific emergency rooms may decrease the risk of blood transfusion in this population.