Venous Thromboembolism After Blood Transfusions in Women Undergoing Hysterectomy for Non-Malignant Indications: A Retrospective Cohort Study.

OBJECTIVE: To quantify the effect of blood transfusion on the risk of venous thromboembolism (VTE) among women undergoing hysterectomy for non-malignant indications. METHODS: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was conducted. Women who underwent hysterectomy for non-malignant indications between 2011 and 2016 were identified using the Current Procedural Terminology and Internationally Classification of Diseases codes. The primary outcome was development of VTE. Data on patient demographics and perioperative variables were obtained. Pair-wise comparison using χ2 tests were performed to compare women with and without VTE. Multivariable logistic regression was performed to adjust for potential confounders and identify independent predictors of VTE. RESULTS: Between 2011 and 2016, 169 593 women underwent hysterectomy for non-malignant indications. The overall incidence of VTE was 0.32%. Patient characteristics associated with VTE included obesity and higher American Society of Anesthesiologists (ASA) status. Associated operative factors included abdominal surgery, blood transfusion, and prolonged operative time (P < 0.05 for all). Following adjustment for potential confounders, abdominal hysterectomy was associated with greater odds of VTE than laparoscopic or vaginal approaches (adjusted odds ratio [aOR] 1.81; 95% CI 1.48-2.21 and aOR 2.31; 95% CI 1.62-3.28, respectively). Greater odds of VTE were also observed with OR time >150 minutes (aOR 1.88; 95% CI 1.46-2.42), ASA class ≥III (aOR 1.53; 95% CI 1.05-2.26), and intra- and postoperative transfusion (aOR 2.65; 95% CI 1.78-3.95 and aOR 2.98; 95% CI 1.95-4.55, respectively). CONCLUSION: The risk of VTE is low in women undergoing hysterectomy for non-malignant indications. Blood transfusion was associated with the highest risk of VTE.

Variation in outcome reporting in studies on obesity in pregnancy-A systematic review.

Although considerable research is being conducted with a view to improve outcomes for pregnant women with obesity and their babies, much of this research is compromised by the quality of outcome reporting. Our aim is to determine how outcomes have been reported and measured in obesity in pregnancy studies, as a first step towards developing a core outcome set to standardize outcome reporting in future trials. We conducted a systematic review of clinical trials and systematic reviews on obesity in pregnancy in accordance with the Preferred Reporting in Systematic Reviews and Meta-analyses guidelines. We searched Medline, Embase, controlled register of trials, World Health Organization International Clinical Trials Registry, www.clinicaltrials.gov and Google Scholar, for relevant studies and extracted study characteristics, outcome reporting and measurement. Reporting quality was assessed using previously published criteria. Outcomes were grouped using a published taxonomy and variations in outcome reporting and measurement were descriptively presented. Seventy included studies yielded a total of 135 outcomes. Foetal/neonatal outcomes were not reported in 53.3% of studies where an intervention could have implications to both, mother and baby. Reported outcomes were mostly physiological/clinical (74.8%), with very limited representation of outcomes related to mortality/survival (5.2%), life impact (7.4%), adverse events (5.9%) and resource utilization (6.7%).