Morbidité et mortalité en anesthésie pour arthroplastie totale de la hanche sur terrain de drépanocytose dans un pays à faible revenu : cas du centre hospitalier Monkole

Abstract

Background: Anaesthesia for hip arthroplasty in patients with sickle cell disease is considered a high-risk procedure. This study investigated morbidity and mortality in a low-income country using Monkole Hospital as an example.Methods. A cross-sectional study of electrophoretically confirmed sickle cell patients anaesthetised at Monkole for hip arthroplasty during the period October 2018 to April 2024. Peri-anaesthetic data up to hospital discharge were collected prospectively and analysed with SPSS 26.0 for p<0.05. Anaesthetic management at Monkole is multidisciplinary. Transfusion exchange, Hb S assay, and systematic cardiorespiratory investigations are not performed. Simple transfusion was carried out with the aim of achieving a haemoglobin level of 7 and 9 g/dl.Results. Eighty-six patients were enrolled. The mean age was 26.02 years, 88.54% were aged 18 and over, and 66.3% were women. BMI was <18.5 kg/mm2 in 48.8%; 84.9% were polytransfused; only 9.3% were on hydroxyurea and only one had received exchange transfusion; 2.3% were icteric and 97.7% were classified ASA III. The mean Hb level was 8.3g/dl, and less than 7g/dL in 15.1% of cases. Antibiotic prophylaxis was administered in all patients with cefazolin ± gentamycin. Spinal anaesthesia (bupivacaine + morphine) was used alone (95.3%), combined with general anaesthesia (3.48%), and the prosthesis was cemented in 95.35% of cases. Intraoperative complications were: arterial hypotension (18.6%), discomfort (4.6%), the effect of cementing (4.6%), poor quality of spinal block (1.6%), haemorrhage (2.3%). Transfusion was required for 79.1% of patients intraoperatively and 3.2% postoperatively. Postoperative complications accounted for 11.6%: anaemia (5.8%), vaso-occlusive crisis (2.3%), urinary retention (2.3%), and vomiting (1.6%). No deaths or acute chest syndrome were recorded. All patients spent one day in intensive care and the average hospital stay was 5 days. Alcohol consumption and procedures lasting longer than two hours were associated with intraoperative complications. Leanness, previous anaesthesia, platelet count below 1500000/mm3, prolonged activated partial thromboplastin time, and the presence of intraoperative complications were associated with postoperative complications.Conclusion. There was no and morbidity was represented by minor complications. It seems possible to anaesthetise patients with sickle cell disease for hip arthroplasty without measuring haemoglobin S or exchanging transfusions, with a lower risk of morbidity and mortality.