Abstract
Objective
To assess the utilization and cost of intraoperative cell salvage (ICS) in minimally
invasive myomectomy.
Study Design
Retrospective cohort study of patients who underwent minimally invasive myomectomy
at a quaternary care academic hospital. Patients were classified into: ICS setup vs
no ICS setup, ICS setup with reinfusion vs ICS setup without reinfusion.
Results
Of 382 patients who underwent minimally invasive myomectomy, 67 (17.5 %) had ICS setup,
30 (44.8 %) of those patients reinfused. Median volume of reinfusion per patient was
300 mL (range 125–1000 mL). Patients who ultimately underwent ICS reinfusion, compared
to those with ICS setup only, had significantly larger mean maximum fibroid size (9.8 cm
vs 8.0 cm, p = 0.02), higher median total specimen weight (367 vs 304 g, p = 0.03),
higher median estimated blood loss (575 vs 300 mL, p < 0.0001), longer mean operative
time (261 vs 215 min, p = 0.04). No perioperative complications were associated with
ICS. Higher costs are associated with universal use or complete lack of ICS; lowest
cost is associated with ICS setup only for those ultimately reinfused.
Conclusion
ICS might reduce requirements for allogeneic blood transfusions in patients undergoing
minimally invasive myomectomy, and may contribute to cost savings. Uterine and maximum
fibroid sizes are possible preoperative indicators for patients who require cell salvage
reinfusion.
Abbreviations:
ICS (intraoperative cell salvage), EBL (estimated blood loss), PRBC (packed red blood cells), ICSS (intraoperative cell salvage setup), NICS (no intraoperative cell salvage setup), ICSR (intraoperative cell salvage setup with reinfusion), ICSNR (intraoperative cell salvage setup with no reinfusion), BMI (Body Mass Index)Keywords
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Biography
Harold Wu : Dr. Harold Yihao Wu is a minimally invasive gynecologic surgeon and researcher who specializes in treating women with abnormal uterine bleeding, uterine fibroids, adenomyosis and endometriosis. He has extensive expertise in minimally invasive surgical procedures to address these conditions. Dr. Wu also conducts clinical research to find ways to continue improving patient care and outcomes.
Biography
Bhuchitra Singh: Dr. Singh is the Clinical Research Program Manager at the Howard W. and Georgeanna Seegars Jones Laboratory. He received his medical degree from Manipal Academy of Higher Science, India, and completed his post graduate training in Epidemiology and Biostatistics from the Johns Hopkins Bloomberg School of Public Health.
Biography
Ting-Tai Yen: Dr. Yen was a research assistant at the Johns Hopkins university School of Medicine.
Biography
Jacqueline Maher: Dr. Maher is an REI fellow at the Johns Hopkins University School of Medicine.
Biography
Shreetoma Datta: Dr. Shreetoma Datta is a research assistant working at the Department of Reproductive Sciences and Women’s Health Research.
Biography
Katherine Chaves: Dr. Chaves was a resident at Johns Hopkins School of Medicine.
Biography
Brandyn Lau: Dr. Brandyn Lau is an assistant professor of surgery and health sciences informatics at the Johns Hopkins University School of Medicine, and associate faculty in the Armstrong Institute for Patient Safety and Quality. His primary research interest is in the use of electronic health record data to improve care quality, patient safety, and clinical education. Clinically, the majority of his effort focuses on the prevention, diagnosis, and treatment of venous thromboembolism (VTE).
Biography
Steven Frank Dr. Steven M. Frank is an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. His area of clinical expertise is anesthesia for vascular, thoracic and transplant surgery, and he is an expert in blood conservation methods.
Biography
Khara Simpson Dr. Khara M. Simpson is an assistant professor in the Johns Hopkins Department of Gynecology and Obstetrics. Prior to joining Johns Hopkins, she was an instructor in obstetrics and gynecology at Columbia University Medical Center. Dr. Simpson’s areas of clinical expertise include minimally invasive gynecologic surgery for conditions ranging from endometriosis to fibroids to ovarian cysts.
Biography
Kristin Patzkowsky: Dr. Kristin Patzkowsky is a board-certified Ob-Gyn and is part of the Minimally Invasive Surgery Group and the Multidisciplinary Fibroid Center for the Division of Gynecologic Specialties at Johns Hopkins. She also holds the title of Assistant Program Director, GYN/OB Residency Program, at Johns Hopkins Hospital.
Biography
Karen Wang: Dr. Karen Wang, is a fellowship-trained minimally invasive gynecologic surgeon whose primary clinical focus is on the surgical management of benign gynecologic conditions, including abnormal bleeding, fibroids, endometriosis, pelvic pain and office procedures. Her research interests include quality and safety, surgical outcomes and surgical training.
Article info
Publication history
Published online: December 09, 2022
Accepted:
December 6,
2022
Received in revised form:
November 29,
2022
Received:
October 6,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
