1424 Impact of a “Blood Conservation Bundle” on Perioperative Transfusion Rates During Myomectomy

Study Objective Myomectomy is a common gynecologic procedure that is associated with high rates of intraoperative blood loss and subsequent blood transfusion. An intraoperative Blood Conservation Bundle (BCB) was developed as a standardized approach to decreasing blood loss during myomectomy. This study aimed to introduce the care bundle into clinical practice and assess its impact on transfusion rates and other perioperative parameters. Design Prospective cohort study with retrospective control group. Setting Canadian tertiary care academic hospital. Patients or Participants Women who underwent myomectomy between November 2018-April 2019 were included in the prospective portion of the study. Women who underwent myomectomy between January 2015-December 2016 were included as a retrospective control group. Interventions We assessed perioperative transfusion rates (primary outcome), intraoperative blood loss and complication rates over a 6-month period following introduction of the BCB. This data was compared to baseline data collected retrospectively over a 24-month period prior to bundle introduction. The BCB is a physical checklist attached to the patient chart and consists of evidence-based medical and surgical interventions. Measurements and Main Results In the 24-month period prior to the introduction of the BCB, 137 myomectomies were performed (90 open, 31 robotic, 16 laparoscopic). Overall transfusion rate during that time period was 16% (18/90 open, 4/31 robotic, 0/16 laparoscopic) and mean intraoperative blood loss was 484 mL. During the study period, 27 myomectomies were performed (15 open, 7 robotic, 5 laparoscopic). Overall transfusion rate was 3.7% (0/15 open, 1/7 robotic, 0/5 laparoscopic), four-fold lower than prior to bundle introduction, and average intraoperative blood loss was 340 mL. There was no increase in intraoperative/postoperative complications. Conclusion Best practice care bundles can improve knowledge translation of guidelines into care delivery. The introduction of a Blood Conservation Bundle was associated with a reduction in blood loss and transfusion rates during myomectomy at our institution.