Open simple prostatectomy and blood transfusion at Kenyatta National Hospital, Nairobi

Abstract

Background Open simple prostatectomy has long been associated with large blood losses; hence allogeneic blood transfusion in this procedure is a standard practice world over. A review of literature suggests significant association between peri-operative blood loss accompanying open simple prostatectomy and certain patient factors18.19.2o.21.22.23.While blood transfusion rate in open simple prostatectomy had been widely investigated in other centres11.12.17.25,this seemed not to be the case at Kenyatta National Hospital. The shortage of blood and blood products in our blood transfusion centres as well as the alarming risks of transfusion reactions and disease dissemination demanded a review of these factors with the aim of reducing morbidity associated with peri-operative blood loss and blood transfusion28.29.3o. Objectives To assess blood loss, determine blood transfusion rate, and define some of the factors associated with peri-operative blood loss and blood transfusion in open simple prostatectomy. Methodology A prospective cohort study was conducted in the urology units of Kenyatta National Hospital, Kenya, between June 2004 and May 2005. Ninety-five patients who were admitted with a clinical diagnosis of benign prostatic hyperplasia and underwent open simple prostatectomy were enrolled into the study upon giving a written informed consent. Data on the study variables including the patients' age, pre-operative medication, clinical presentation, preoperative systolic blood pressure, American Society of Anaesthesiologists (ASA) grade, preand post- operative. haemoglobin levels, technique of anaesthesia, technique of open simple prostatectomy, weight of resected prostatic tissue, blood loss estimation, units of blood transfused, and the duration of hospital stay was collected and analysed. The peri-operative blood loss was judged from the mean decrease in peri-operative haemoglobin concentration. The mean decrease in haemoglobin was derived from the pre- and post-operative haemoglobin. The post-operative haemoglobin for the patients transfused peri-operatively was corrected for the transfused volume by subtracting 19/dl for each transfused unit of blood". The main study outcome was defined as the mean decrease in peri-operative haemoglobin and blood transfusion rate. Results Ninety-five patients who underwent open simple prostatectomy for benign prostatic hyperplasia were enrolled into the study. Their median age was 70 years (Range 50 to 97). The mean decrease in haemoglobin concentration, which was the main indicator of peri-operative blood loss, was 2.1g/dl (± 1.4). The peri-operative blood transfusion rate was 36.8%. Twenty-four (68.6%) of the patients who received either 1 or 2 units of blood had a pre-operative haemoglobin level above 13.5g/dl and a post-operative haemoglobin level above 11.5g/dl, while 11 (31.4%) had severe peri-operative bleeding, that necessitated immediate surgical reintervention. A total of 68 units of blood was transfused, 42 (61.8%) allogeneic and 26 (38.2%) autollogous blood. The post-operative median hospitalisation time was 8 days (Range 4 to 35). There were 2 (2.1%) post-operative deaths and both patients had intractable intra- and post-operative bleeding, massive blood transfusion and disseminated intravascular coagulopathy. The factors that were significantly associated with peri-operative blood loss and blood transfusion in open simple prostatectomy were patient's age above 70 years, pre-operative use of acetyl-salicylate or warfarin sodium, pre-operative systolic blood pressure above 140mmHg, general anaesthesia, Freyer's (transvesical) technique and the weight of resected prostatic tissue above 70g. Conclusion Open simple prostatectomy performed under spinal anaesthesia using Millin's (retropubic) technique is associated with minimal blood loss. The peri-operative blood transfusion rate was 36.8% and most of the blood transfusion was clinically unjustified. Transfusion of autollogous blood in open simple prostatectomy was underutilized at Kenyatta National Hospital.