Abstract
Patients with sickle cell disease are more likely to undergo surgery during their lifetime, especially given the numerous complications they may develop. There is a paucity of data concerning the management of patients with sickle cell disease by anaesthesiologists, especially in Africa. This study aimed to describe the practices of anaesthesiologists in Cameroon concerning the perioperative management of patients with sickle cell disease. A cross-sectional study was carried out over four months and involved 35 out 47 anaesthesiologists working in hospitals across the country, who were invited to fill a data collection form after giving their informed consent. The data were analysed using descriptive statistics and a binary logistic regression model. Among the 35 anaesthesiologists included in the study, most (29 (82.9%)) had managed patients with sickle cell disease for both emergency and elective surgical procedures. Most of them had never asked for a haematology consultation before surgery. Most participants (26 (74.3%)) admitted to having carried out simple blood transfusions, while 4 (11.4%) carried out exchange transfusions. The haemoglobin thresholds for transfusion varied from one practitioner to another, between <6 g/dL and <9 g/dL. Only 6 (17.1%) anaesthesiologists had a treatment guideline for the management of patients with sickle cell disease in the hospitals where they practiced. Only 9 (25.7%) prescribed a search for irregular agglutinins. The percentage of haemoglobin S before surgery was always available for 5 (14.3%) of the participants. The coefficient (0.06) of the occurrence of a haematology consultation before surgery had a significant influence on the probability of management of post-operative complications (coefficient 0.06, 10% level of probability). This study highlights the fact that practices in the perioperative management of patients with sickle cell disease in Cameroon vary greatly from one anaesthesiologist to another. We disclosed major differences in the current recommendations, which support the fact that even in Sub-Saharan countries, guidelines applicable to the local settings should be published.
Highlights
Sickle cell disease is an autosomal recessive genetic disease resulting in an abnormal structure and quality of haemoglobin [1]
Binary logistic regression best fits a non-linear relationship between variables and its probability lies between 0 and 1. This model hypothesised the extent to which the practices of anaesthesiologists are influenced by factors such as gender; age; hospital category; haematology consultation before surgery; number of years in the practice of anaesthesia; and number of patients with sickle cell disease managed per year
The binary logistic regression model was specified as: Z = α + β1Gender + β2Age + β3Hospital Category + β4 Haematology consultation before surgery + β5 Number of years in practice of anaesthesia + β6 Number of patients with sickle cell disease managed per year + μ
Summary
Sickle cell disease is an autosomal recessive genetic disease resulting in an abnormal structure and quality of haemoglobin [1] It is the most common genetic disorder, with over 50 million cases worldwide, and more than half of these cases (30 million) occur in Sub-Saharan Africa [2]. Most of these patients will undergo surgery during their lifetime [3] owing to a debilitating systemic syndrome characterised by chronic haemolytic anaemia, vaso-occlusive phenomena, ischaemia-reperfusion episodes with organ infarction, susceptibility to bacterial infection and chronic organ damage. Considering the paucity of African data, our study aimed to describe the practices of anaesthesiologists in the management of patients with sickle cell disease in Cameroon
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