Factors Associated with Morbidity and Mortality in Anesthesia During Intra-Abdominal Surgery in Sickle Cell Patients in a Low-Income Country: The Case of Centre Hospitalier Monkole

Abstract

Objective: This study investigated the factors associated with morbidity and mortality in sickle cell patients anesthetized for intra-abdominal surgery in Monkole. Methods: Prospective study conducted in sickle cell patients anesthetized for intra-abdominal surgery (excluding cesarean section) from 01/01/2011 to 12/31/2020 and recruited exhaustively and consecutively. The variables studied were pre, per and postoperative until discharge from hospital. Data were analyzed with SPSS 24.0 for p < 0.05. Results: Of 258 anesthetized sickle cell patients, 74 were for intra-abdominal surgery, including 59.5% of women with an average age of 16.4 years. The majority (95%) were transfused several time, 18% were under hydrea and none under exchange transfusion. Jaundice was present in 49%, heart murmur in 22%, 96% were ASA III. Anesthetic duration was ≥ 2 hours in 59.5%. Simple transfusion was done in 63.5% of cases. Intraoperative incidents accounted for 4% (bronchospasm, hypercapnia and allergy). Postoperative complications (anemia, parietal infection, convulsions, pancreatitis, pneumonia) accounted for 20% and 3 deaths were recorded (sepsis: 2 and pulmonary embolism: 1). Splenic surgery [ORa: 4.35 (1.51-7.20 95% CI) p=0.018]; the presence of jaundice [ORa: 3.18 (1.04-7.80 95% CI) p=0.024] and duration of anesthesia ≥ 2 hours [ORa: 9.09 (1.27-12.87 95% CI p=0.033] were the determinants of intraoperative transfusion. Heart murmur [ORa: 10.50 (2.77-13.76 95% CI) p=0.001] and hemoglobin <6g/dl [ORa: 3.08 (2.82-17.59 95% CI) p =0.008] were associated with postoperative complications. Conclusion: Morbi-mortality seems linked to the severity of the surgery and the pathology and not to the anesthesia act.