Effect of perioperative blood transfusion on complications following emergency non-trauma laparotomy in Mulago hospital: A prospective cohort study.

Abstract

Background: Blood transfusion may be required in the management of patients undergoing emergency non-trauma laparotomy. However, several retrospective cohort studies involving patients undergoing laparotomy for benign and malignant indications have identified blood transfusion as a significant predictor of postoperative infections and mortality. Still, no study has explored such an association in our setting. We aimed to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a low-resource setting. Methods: In this prospective cohort study, we recruited 160 adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure and non-exposure. Independent variables, including perioperative blood transfusion and confounders, were recorded on entry, while dependent variables, including the presence or absence of surgical site infection and mortality, were obtained over a 30-day follow-up period. Data were analysed using EPI INFO version 7, SPSS version 29 & Stata version 14. Results: All 160 participants recruited, 28 (17.5%) transfused (exposed) and 132 (82.5%) not transfused (non-exposed), were included in the final analysis. Transfusion exposure (RR, 7.81; 95% CI, 2.58 – 23.63; p=0.0003) and preoperative leucocytosis/leucopoenia (RR, 2.19; 95% CI, 1.04 – 4.65; p=0.040) were identified as independent risk factors for SSI after multivariate logistic regression analysis adjusted for confounders including preoperative anaemia, young-to-middle-aged adults, cloudy/purulent/feculent exudate, gut perforation diagnosis, female sex, and registrar-led surgical team. Furthermore, transfusion exposure (HR, 3.36; 95% CI, 1.11 – 10.25; p=0.033) and old age (HR, 5.50; 95% CI, 1.67 – 18.11; p=0.005) were identified as independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders including high ASA score, immunodeficiency, cloudy/purulent/feculent exudate, bowel obstruction and high-risk procedure for bowel leak. Conclusion: Among patients undergoing emergency non-trauma laparotomy, perioperative blood transfusion compared to no perioperative blood transfusion increased the risk of 30-day SSI by 7.81 and the 30-day mortality risk by 3.36. A restrictive transfusion strategy and a more extensive multicentre prospective cohort study are recommended.