INCIDENCE AND FACTORS ASSOCIATED WITH BLOOD TRANSFUSION IN A SAMPLE OF SOUTH AFRICAN PATIENTS UNDERGOING PRIMARY HIP ARTHROPLASTY: A RETROSPECTIVE DATABASE STUDY.

Safwana Essa; Marsha  Ramburuth; Yoshan Moodley

doi:10.51168/sjhrafrica.v4i6.448

Authors

Safwana Essa (MBChB) Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Berea 4001, Durban, South Africa.
Marsha Ramburuth (MBChB) Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Berea 4001, Durban, South Africa.
Yoshan Moodley (PhD) Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zyl Drive, Parow 7505, Cape Town, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v4i6.448

Keywords:

Hip arthroplasty, hip replacement, blood loss, blood transfusion, South Africa

Abstract

Background:

Despite improvements in arthroplasty and blood conservation practices, surgical blood loss remains a challenge. The blood products used to address perioperative bleeding are scarce and should be effectively managed. Our study objectives were to 1) establish the cumulative incidence of peri-operative transfusion in a sample of South African primary hip arthroplasty patients and 2) identify factors associated with transfusions.

Methods:

This study was a sub-analysis of an existing database of 174 adult primary hip arthroplasty patients who underwent surgery at Inkosi Albert Luthuli Central Hospital between 01 January 2015 and 30 June 2016. A retrospective chart review process was used to collect the data analyzed using descriptive statistical methods, Mann-Whitney testing, and Chi-squared testing. The study outcome was perioperative blood transfusion, defined as receipt of at least 1 unit of packed red cells anytime between the surgical incision and discharge from the hospital.

Results:

The incidence of perioperative blood transfusion was 13.8% (95%CI: 9.0-19.8%). The median number of blood units received was 2.0 (Range: 1.0-4.0) units. The proportion of patients who received blood transfusions was higher in those who had longer surgery (41.7% vs. 14.7 % p=0.002) or received postoperative thromboprophylaxis (91.7% vs. 68% p=0.017).

Conclusion:

The incidence of perioperative blood transfusion observed in our study of patients undergoing primary hip arthroplasty was within range of that reported in international studies. Longer surgery and postoperative thromboprophylaxis are potentially important predictors of perioperative transfusion following hip arthroplasty in our setting. We recommend further research to confirm our findings.

Author Biographies

Safwana Essa (MBChB), Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Berea 4001, Durban, South Africa.

received her medical degree from the University of Kwa-Zulu Natal, South Africa in 2015. She developed an interest and passion for anaesthetics during medical internship and community service training. She is currently a third-year registrar in Anaesthetics at the University of KwaZulu-Natal and hopes to improve perioperative healthcare practices on the African continent through her future research. This research manuscript is a compulsory component of Safwana Essa’s registrar training.

Marsha Ramburuth (MBChB), Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Berea 4001, Durban, South Africa.

is a consultant anaesthetist practicing in the public-sector in Durban, South Africa. She is also an honorary lecturer in anaesthetics at the University of KwaZulu-Natal. Her research focus is risk stratification and perioperative outcomes in South African patients. She was the supervisor for Safwana Essa’s research study.

Yoshan Moodley (PhD), Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zyl Drive, Parow 7505, Cape Town, South Africa.

is an NRF C2-rated scientist at the Department of Global Health, Stellenbosch University, Cape Town, South Africa. He is also an honorary researcher at the Central University of Technology, Bloemfontein, South Africa. He has a particular interest in the epidemiology of perioperative outcomes, and was the co-supervisor for Safwana Essa’s research study.