title: Postoperative Infection in the Setting of Massive Intraoperative Blood Loss.
abstract: To determine the local rates of massive intraoperative blood loss and subsequent infectious morbidity for patients undergoing gynaecologic laparotomy.
  
  
  
  We performed a retrospective chart review of all patients undergoing gynaecologic laparotomy between January 1, 2013 and December 31, 2013 to identify cases of massive intraoperative blood loss (defined as ≥1 L estimated intraoperative blood loss, a postoperative reduction in hemoglobin concentration of ≥40 g/L, or a perioperative blood transfusion). For cases meeting these criteria, we abstracted further data to assess the rate of postoperative infectious morbidity (defined as a positive wound swab culture, positive urine culture, or satisfying the 1991 criteria for systemic inflammatory response syndrome).
  
  
  
  The rate of massive intraoperative blood loss was 13.5% (n = 69). The average age in this cohort was 50.4 years (range 18-84 years) and the average BMI was 27.9 kg/m2. Perioperative transfusion was required in 31.9% (n = 22). Notably, 26.1% of patients (n = 18) met one of our primary endpoints for postoperative infectious morbidity. A further 10.1% (n = 7) had morbidities including hyponatremia, wound dehiscence, intra-abdominal abscess, positive blood cultures, acute respiratory distress syndrome, myocardial infarction, intensive care unit admission, or death.
  
  
  
  Our rate of massive intraoperative blood loss during gynaecologic laparotomy was found to be 13.5%, and our rate of postoperative infectious morbidity subsequent to massive intraoperative blood loss was 26.1%.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB.
authors.forename: Melike
authors.initials: M
authors.lastname: Leylek
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Poliquin
authors.affiliation: Division of Gynecologic Oncology, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al-Wazzan
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB; Division of Gynecologic Oncology, Cancer Care Manitoba, Winnipeg MB.
authors.forename: Erin
authors.initials: E
authors.lastname: Dean
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB; Division of Gynecologic Oncology, Cancer Care Manitoba, Winnipeg MB.
authors.forename: Alon D
authors.initials: AD
authors.lastname: Altman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D014946:Wound Infection / Q000453:epidemiology*; D055815:Young Adult
keywords: Operative blood loss; febrile morbidity; gynaecologic laparotomy; peri-operative morbidity