Authors: Mbombo W, Mbuyamba J, Mosolo A, Mbuyi F, Nkodila A, Isengingo C, Kambala P, Bazeboso JA, Mbala T, Kazadi V, Mukaba P, Mbala R, Ilunga JP, Mukuna P, Kashala R, Kabwe B, Kabango R, Nsiala J, Bula-Bula M, Barhayiga B, Makulo JR, Ngiyulu JR, Tshilolo L.
Objective: This study investigated the factors associated with morbidity and mortality in sickle cell patients anesthetized for intra-abdominal surgery in Monkole.
Methods: Prospective study conducted in sickle cell patients anesthetized for intra-abdominal surgery (excluding cesarean section) from 01/01/2011 to 12/31/2020 and recruited exhaustively and consecutively. The variables studied were pre, per and postoperative until discharge from hospital. Data were analyzed with SPSS 24.0 for p < 0.05.
Results: Of 258 anesthetized sickle cell patients, 74 were for intra-abdominal surgery, including 59.5% of women with an average age of 16.4 years. The majority (95%) were transfused several time, 18% were under hydrea and none under exchange transfusion. Jaundice was present in 49%, heart murmur in 22%, 96% were ASA III. Anesthetic duration was ≥ 2 hours in 59.5%. Simple transfusion was done in 63.5% of cases. Intraoperative incidents accounted for 4% (bronchospasm, hypercapnia and allergy). Postoperative complications (anemia, parietal infection, convulsions, pancreatitis, pneumonia) accounted for 20% and 3 deaths were recorded (sepsis: 2 and pulmonary embolism: 1). Splenic surgery [ORa: 4.35 (1.51-7.20 95% CI) p=0.018]; the presence of jaundice [ORa: 3.18 (1.04-7.80 95% CI) p=0.024] and duration of anesthesia ≥ 2 hours [ORa: 9.09 (1.27-12.87 95% CI p=0.033] were the determinants of intraoperative transfusion. Heart murmur [ORa: 10.50 (2.77-13.76 95% CI) p=0.001] and hemoglobin <6g/dl [ORa: 3.08 (2.82-17.59 95% CI) p =0.008] were associated with postoperative complications.
Conclusion: Morbi-mortality seems linked to the severity of the surgery and the pathology and not to the anesthesia act.