Effect of Perioperative Blood Transfusion on Complications Following Emergency Non-trauma Laparotomy in Mulago Hospital: A Prospective Cohort Study.

Abstract

Background Although blood transfusion may be required during emergency non-trauma laparotomy, several retrospective cohort studies have identified blood transfusion as a significant predictor of postoperative infections and mortality. However, no study has explored such an association in a resource-limited setting. This study aims to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections (SSIs) and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a resource-limited setting. Methodology In this prospective, single-center, cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure status. Transfusion exposure and possible confounders were recorded on entry, while the presence or absence of SSIs and mortality were obtained over 30 days of follow-up. The data were analyzed using Epi Info version 7 and Stata version 14. P-values <0.05 indicated statistical significance. Results All 160 participants recruited, 28 (17.5%) transfusion-exposed and 132 (82.5%) non-exposed, were included in the final analysis. Transfusion exposure (relative risk = 8.16; 95% confidence interval (CI) = 2.73-24.37; p < 0.001) was an independent risk factor for SSI after multivariate logistic regression analysis adjusted for confounders. Inverse probability weighting with regression adjustment (IPWRA) revealed that transfusion exposure significantly increased the incidence of SSI by 36.2% (95% CI = 14.2%-58.2%; p = 0.001). Furthermore, transfusion exposure (hazard ratio (HR) = 3.62; 95% CI = 1.28-10.27; p = 0.015) and age ≥60 years (HR = 5.97; 95% CI = 1.98-18.01; p = 0.002) were independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders. IPWRA revealed that transfusion exposure significantly increased the incidence of mortality by 17.6% (95% CI = 1.4%-33.8%; p = 0.033). Conclusions This study suggests an independent association between perioperative blood transfusion and the occurrence of SSIs and mortality among patients undergoing emergency non-trauma laparotomy. A larger multicenter prospective cohort study considering more confounders and the use of established restrictive transfusion protocols is recommended.