LAUSR

STUDY OBJECTIVE The primary objective was to introduce an intraoperative Blood Conservation Bundle (BCB) checklist into clinical practice and assess its impact on perioperative blood transfusion rates during myomectomy. STUDY DESIGN Prospective cohort study with retrospective control group SETTING: A Canadian tertiary-care teaching hospital PATIENTS: One hundred and eighty-six women who underwent myomectomy INTERVENTIONS: The BCB is a physical checklist attached to the patient chart consisting of evidence-based medical and surgical interventions to reduce intraoperative blood loss. It was introduced in October 2018 and data were collected prospectively during a 12-month period for all open, robotic and laparoscopic myomectomies at our institution. Primary outcome was perioperative transfusion rate and secondary outcomes included estimated intraoperative blood loss (EBL), perioperative complications, readmissions, and BCB utilization rates. Data were compared to a historical control group from the 24-month period prior to BCB introduction. MEASUREMENTS AND MAIN RESULTS In the pre-BCB period, 134 myomectomies (90 open, 31 robotic and 13 laparoscopic) were performed and during our study period 52 myomectomies (33 open, 10 robotic and 9 laparoscopic) were performed. There was a decrease in transfusion rate from 15.7% (21/134) to 7.7% (4/52) following introduction of the BCB, however this was not significant (p=.152). Mean EBL was lower post-intervention [491 +/- 440mL vs. 350 +/- 255mL, p<.05] as was the mean delta hemoglobin (∆Hb) [-28 +/- 13.0g/L vs. -23 +/- 11.4g/L, p<.05]. The checklist was used in 92.3% of cases (48/52). There was no difference in intraoperative or postoperative complications or readmission rate. CONCLUSION Best practice care bundles can improve knowledge translation of guidelines into care delivery.  The introduction of a BCB was successful in reducing intraoperative blood loss during myomectomy at our institution. The BCB is a simple, effective tool that can be easily adopted by gynecologic surgeons to guide intraoperative decision-making during myomectomy.