Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years

Nwafor, Ikechukwu A.; Arua, Onyinyechukwu A; Eze, JC; Ezemba, N; Nwafor, Maureen N.

doi:10.1017/s1047951118001269

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The density of the cardiothoracic surgeons could be directly related to the distribution of gross developmental product and the health budget, but it was not a determinant factor for sustainability and success of the cardiac programmes. 1,22 Model D is largely practised in southwestern region and some centres there have transited to independence. See Table 2.…”

Section: Discussionmentioning

confidence: 99%

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

2019

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Background:In any country, the development of open heart surgery programme parallels stable political climate, economic growth, good leadership, and prudent fiscal management. This is lacking in a country like Nigeria without a functional cardiac hospital.Objective:To review and compare the various models being adopted towards establishing a sustainable open heart surgery programme in Nigeria.Materials and Methods:For ethnic and cultural reasons, Nigeria is divided into six geopolitical regions. Each region has one or more Federal Teaching Hospitals including medical centres. The hospitals have trained cardiothoracic surgeons and cardiologists as well as other auxiliary staff. After attainment of democratic rule in 1999, individual hospitals have devised various models to establish sustainable open heart surgery programme. The number of hospitals in each region, the models devised, and the limitations including the outcome were studied and analysed.Results:Each geopolitical zone has about three to four centres, either public or private, trying to establish the programme. There are six different models. Each centre has been trying the different models since the year 2000. The oldest of the model is cardiac mission and the newest is employment of highly skilled retired expatriate consultant cardiac surgeon to help develop the local team. Inadequate funds, lack of governmental support, and brain drain syndrome have largely affected the programme.

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Section: Discussionmentioning

confidence: 99%

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

2019

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“…Patient blood management (PBM) is a multimodal, multidisciplinary approach that centers around three main goals: improving preoperative red blood cell (RBC) counts as through the early detection and treatment of anemia, minimizing intraoperative blood loss through strategies such as intraoperative cell salvage (ICS), and optimizing the patient-specific tolerance of anemia ( 2 ). PBM can alleviate the pressure placed on blood resources while also reducing rates of transfusion-related complications and contributing to improved postoperative patient outcomes ( 3 ). ICS and the infusion of sRBCs form key components of PBM strategies in cardiac surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Zhou

Chen

et al. 2023

Front. Med.

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BackgroundThis study was designed to explore factors associated with the incidence of positive bacterial culture of salvaged red blood cells (sRBCs) recovered with a Cell Saver instrument during cardiac surgery and the impact of such positive outcomes on postoperative infection-related morbidity.MethodsThe cohort study enrolled 204 patients scheduled for cardiac surgery with intraoperative blood cell salvage and retransfusion from July 2021 to July 2022. These patients were stratified into two groups based on intraoperative sRBCs bacterial culture results: culture (+) and culture (−) groups. Preoperative and intraoperative variables were compared between these groups aim to detect possible predictors of positive culture in sRBCs. In addition, differences in postoperative infection-related morbidity and other clinical outcomes were compared between these groups.ResultsOf these patients, 49% were sRBCs culture (+), with Staphylococcus epidermidis as the most commonly identified pathogen. Risk factors independently associated with the risk of positive culture in sRBCs included BMI ≥25 kg/m2, a history of smoking, an operative duration ≥277.5 min, the higher number of staff in the operating room and higher surgical case order. Patients in the sRBCs culture (+) group exhibited a longer average ICU stay [3.5 days (2.0–6.0) vs. 2 days (1.0–4.0), P < 0.01], a longer duration of ventilation [20.45 h (12.0–17.8) vs. 13 h (11.0–17.0, P = 0.02)], underwent more allogeneic blood transfusions, exhibited higher transfusion-related costs [2,962 (1,683.0–5,608.8) vs. 2,525 (1,532.3–3,595.0), P = 0.01], and had higher rates of postoperative infections (22 vs. 9.6%, P = 0.02) as compared to patients in the sRBCs culture (−) group. In addition, culture (+) in sRBCs was an independent risk factor for postoperative infection (OR 2.62, 95% CI 1.16–5.90, P = 0.02).ConclusionStaphylococcus epidermidis was the most common pathogen detected in sRBCs in the culture (+) group in this study, identifying it as a potential driver of postoperative infection. Positive sRBCs culture may contribute to postoperative infection and its incidence was significantly associated with patient BMI, history of smoking, operative duration, the number of staff in the operating room and surgical case order.

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“…2 With an increase in second thoracotomies following openheart surgery, intraoperative bleeding and postoperative anaemia have become common factors affecting the prognosis of patients undergoing such operations. 3 Routine surgical procedures can lead to tissue damage and blood loss; and fibrinolysis at the surgical site increases 4-8 times more than usual. 4 The degree of fibrinolysis depends on the amount of damaged tissue and the type of surgery.…”

Section: Introductionmentioning

confidence: 99%

Intravenous transfusion of iron sucrose reduces blood transfusions and improves postoperative anaemia after a second thoracotomy: a propensity-score matching study

et al. 2020

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Objective: To evaluate the efficacy of intravenous iron sucrose (IS) in the perioperative period of a second thoracotomy after open-heart surgery. Methods: This study enrolled patients that underwent a second thoracotomy after previous open-heart surgery. Propensity-score matching was used to match patients that received oral iron therapy with those that received IS after admission. The baseline demographic and clinical characteristics, perioperative data and adverse outcomes were compared between these two matched groups. Results: The study enrolled 447 patients: of these, 148 received oral iron therapy and effective dietary guidance; and 299 patients received 300 mg IS per week. After matching the propensity scores, there were no significant differences between the two groups in terms of age, sex, smoking history, incidence of major cardiac adverse events, Euro-score, time between the two thoracotomies, application of recombinant erythropoietin, haemoglobin (Hb) on admission and red blood cell (RBC) count on admission. The differences between the two groups after propensity-score matching in terms of the amount of RBC input and Hb after the operation were significant.

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Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years

Abstract: Open heart procedure is a very complex procedure requiring cardiopulmonary bypass with associated severe perioperative bleeding. The attendant blood loss and haemostatic challenges are combated by intricate and selective transfusions of allogeneic blood and or blood products.

Cited by 5 publications

References 23 publications

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Intravenous transfusion of iron sucrose reduces blood transfusions and improves postoperative anaemia after a second thoracotomy: a propensity-score matching study

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