Clinical utility of postoperative hemoglobin level testing following total laparoscopic hysterectomy.
OBJECTIVE
To determine the clinical utility of hemoglobin level testing in guiding postoperative care following total laparoscopic hysterectomies performed for benign indications.


METHODS
Retrospective cohort study.


RESULTS
A total of 629 women underwent total laparoscopic hysterectomies during the 24 month study period. Only 16 (2.5%) developed symptoms and/or signs suggestive of hemodynamic compromise. When compared to asymptomatic patients, symptomatic patients had a larger decrease in postoperative hemoglobin level (2.66 vs 1.80g/dL, P = .007) and were more likely to undergo blood transfusion, pelvic imaging or reoperation (P < .001). Women with a smaller body mass index and/or higher intraoperative intravenous fluid volume were more likely to have a larger decrease in postoperative hemoglobin level (P < .05). Past surgical history, duration and complexity of the hysterectomy, estimated surgical blood loss, uterine weight, and perioperative use of intravenous ketorolac were not associated with a greater decrease in postoperative hemoglobin (P > .05). Using the University of Pittsburgh Medical Center's annual laparoscopic hysterectomy rate and insurance companies' reimbursement for blood hemoglobin testing, we estimated the national annual cost for hemoglobin testing following total laparoscopic hysterectomy to be $2,804,662.


CONCLUSIONS
Hemoglobin level testing has little clinical benefit following elective total laparoscopic hysterectomy and should be reserved for patients who develop signs or symptoms suggestive of acute anemia. Heath care cost savings can be substantial if this test is no longer routinely requested following total laparoscopic hysterectomies.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.
Dina J
DJ
Chamsy
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.
Michelle Y
MY
Louie
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.
Deirdre A
DA
Lum
Department of Economics and Statistics, Duquesne University, Pittsburgh, PA.
Amy L
AL
Phelps
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: manssm@upmc.edu.
Suketu M
SM
Mansuria
D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000191:economics; D010535:Laparoscopy / Q000009:adverse effects* / Q000191:economics; D008875:Middle Aged; D011182:Postoperative Care; D011184:Postoperative Period; D012189:Retrospective Studies
D006454:Hemoglobins
hemoglobin; hysterectomy; laparoscopy; postoperative bleeding