Perioperative Hemoglobin Decline After Deep Endometriosis Surgery: Association with Surgery Duration and Exploratory Analyses of Operative Extent

Background/Objectives: Deep endometriosis surgery may require bowel and multiorgan procedures, but reported blood loss and complications do not fully characterize postoperative hemoglobin decline, a relevant consideration for patient blood management. We aimed to quantify the frequency of a hemoglobin decline of ≥3 g/dL and its association with surgery duration, with secondary exploratory analyses of operative extent.

Methods

This retrospective single-center study in Opole, Poland, linked registry and laboratory records for first eligible surgeries during 2020–2025. Decline was the last preoperative hemoglobin within 7 days minus the recorded nadir through postoperative day 3. The ≥3 g/dL threshold was operational, not a validated minimum clinically important difference. Multivariable models examined binary and continuous decline; exploratory analyses assessed operative extent.