Egbe Flavius E, Iranya Richard N, Dimala Christian A, Mbiine Ronald, Okello Michael, Okeny Paul K
Surgery, Makerere University College of Health Sciences, Kampala, UGA.
Surgery, Moyo General Hospital, Moyo, UGA.
Cureus. 2024 Jul 30;16(7):e65759. doi: 10.7759/cureus.65759. eCollection 2024 Jul.
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.
尽管在急诊非创伤性剖腹手术期间可能需要输血，但多项回顾性队列研究已将输血确定为术后感染和死亡率的重要预测因素。然而，尚无研究在资源有限的环境中探讨这种关联。本研究旨在确定在资源有限环境下的一家大型城市三级医院中，围手术期输血对急诊非创伤性剖腹手术患者手术部位感染（SSI）30天风险和死亡率的影响。
在这项前瞻性、单中心队列研究中，我们招募了160例在急诊非创伤性剖腹手术后48小时入住普通外科病房的连续成年患者。我们根据输血暴露状态对他们进行分组。输血暴露情况和可能的混杂因素在入院时记录，而SSI的存在与否以及死亡率则在30天的随访期间获得。数据使用Epi Info 7版本和Stata 14版本进行分析。P值<0.05表示具有统计学意义。
最终分析纳入了所有招募的160名参与者，其中28名（17.5%）有输血暴露，132名（82.5%）无输血暴露。在对混杂因素进行多因素逻辑回归分析后，输血暴露（相对风险=8.16；95%置信区间（CI）=2.73 - 24.37；p<0.001）是SSI的独立危险因素。回归调整的逆概率加权法（IPWRA）显示，输血暴露使SSI的发生率显著增加了36.2%（95%CI = 14.2% - 58.
