Incidence of Blood Transfusion and Associated Practices during Major Elective Surgery at Mulago Hill Hospitals

Abstract

Background: The goal of care to safe surgery is to control surgical bleeding and directed resuscitation, and blood components are required in resuscitation (White et al., 2015). Significant morbidity is associated with liberal transfusion practice. We set out to determine the incidence of blood transfusion and associated health provider practices during the perioperative management of patients undergoing elective surgeries at Mulago Hill Hospitals.Methodology: Multi-centre observational (prospective cohort) study at MNSH, MSWNH and UCI. Data was collected from 1015 patients using a standardised tool, and 906 were analysed using STATA 15. Results: Perioperative blood transfusion incidence was 23.2% (95% CI 20.5 - 26.1), with 65.2% occurring intraoperatively. The incidence was highest among children and adolescents at 28% and 33%, respectively and lowest among adults at 21%. The prevalence of anaemia was 42% and was not adequately investigated when present. 78.6% of the patients with anaemia had no interventions to address it and were approached by blood transfusion in 59.4% of those treated. Only 5.6% of the products remained under blood bank conditions. Estimation and documentation of blood loss was done in 63.9% of the patients. Five hundred sixty-six blood units were availed and 53% were unused at the end of the 24-hour follow-up period. 32.7% of the patients received pro-coagulant drugs as the sole blood-saving strategy. All the blood transfusions were allogenic. No patient had a haemoglobin assessment before intraoperative or postoperative transfusion.Conclusion: In Mulago Hill Hospitals, the incidence of perioperative transfusion was 23.2% in major elective surgical patients. The study found shortcomings in health providers’ blood transfusion practices, patient management strategies and documentation practices.