Effect of perioperative blood transfusion on complications following emergency non-trauma laparotomy: A prospective cohort study

Abstract

Introduction: Blood transfusion may be required in the management of patients undergoing emergency non-trauma laparotomy. However, retrospective cohort studies involving patients undergoing emergency laparotomy have identified blood transfusion (BT) as a significant predictor of postoperative infection. Still, no study has explored such an association in our setting.

Objective: We aimed to determine the effect of perioperative BT on the 30-day risk of surgical site infections (SSI) and mortality among patients undergoing emergency non-trauma laparotomy in Mulago National Referral Hospital (MNRH).

Methods: In this prospective cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards of MNRH 48 hours following emergency non-trauma laparotomy and grouped them based on transfusion exposure and non-exposure. Independent variables, including perioperative blood transfusion and confounders, were recorded on entry, while dependent variables, including presence or absence of SSI and mortality, were obtained upon 30 days’ follow-up. Data was analysed using EPI INFO-7, SPSS-29, and Stata-14; p<0.05 was considered statistically significant.

Results: All 160 participants recruited, 28 (17.5%) transfused and 132 (82.5%) not transfused, were included in the analysis. Transfusion exposure (RR, 7.81; 95% CI, 2.58 – 23.63; p=0.0003) and preoperative leucocytosis/leukopenia (RR, 2.19; 95% CI, 1.04 – 4.65; p=0.040) were identified as independent risk factors for SSI after multivariate logistic regression adjusted for confounders. Furthermore, for 30-day mortality, transfusion exposure (HR, 3.36; 95% CI, 1.11 – 10.25; p=0.033) and old age ≥60 years (HR, 5.50; 95% CI, 1.67 – 18.11; p=0.005) were identified as independent risk factors for mortality after multivariate Cox regression analysis adjusted for confounders.

Conclusion: Among patients undergoing emergency non-trauma laparotomy, perioperative BT compared to no perioperative BT increased the 30-day SSI risk by 7.81 and the 30-day mortality risk by 3.36. Use of established transfusion protocols, observing aseptic technique, improving surgical technique, use of antibiotic coverage and close monitoring are recommended.