Comparison of postoperative complications in sickle cell disease according to a preoperative transfusion

Position du problème et objectif(s) de l’étude

Sickle-cell disease (SCD) is an inherited hemolytic anemia that leads to multiple vascular complications. These patients often require surgical interventions associated with acute or persistent organ dysfunction such as cholecystectomy or splenectomy. Preoperative red blood cell (RBC) transfusion in sickle-cell patients is acknowledged to lower the proportion of hemoglobin S (HbSS), suppress erythropoiesis, and improve anemia. In some studies, it has been associated with reduced risk of postoperative complications as well as an enhanced recovery. There is no consensus between international guidelines on whether preoperative blood transfusions are beneficial in patients with sickle-cell disease (SCD). The aim of this study was to compare postoperative complications among those who received or not a preoperative red blood transfusion.

Matériel et méthodes

This retrospective study focused on a French Caribbean cohort of sickle cell patients who underwent a surgery between January 2012 and December 2022. It was conducted at the University Hospital of La Guadeloupe. Patients were divided into two groups: group 1 was given no preoperative transfusion or exchange transfusion and group 2 received a preoperative RBC transfusion or exchange transfusion.The primary outcome was the occurrence of vaso-occlusive crisis (VOC). The secondary outcome was the occurrence of another serious complication such as acute chest syndrome (ACS), intensive care unit (ICU) admission or death. Propensity score matching methods were used to obtain two statistically similar cohorts of patients among those who received or not a preoperative red blood cell transfusion. Each patient was assigned a propensity score reflecting the probability of receiving transfusion.

Résultats & Discussion

We documented a total of 187 patients, with 116 patients (62%) undergoing preoperative transfusion and 71 (38%) not receiving preoperative transfusion. The prevalence of severe complications within our cohort stood at 29 patients, or 15.5%, encompassing 15 cases (8%) of vaso-occlusive crises (VOC), 8 cases (4%) of acute chest syndrome (ACS), 6 cases (3%) of pulmonary embolism (PE), 5 cases (3%) resulting in mortality, and 22 cases (12%) necessitating admission to the intensive care unit. Univariate analyses conducted on unmatched data unveiled several factors associated with an elevated risk of postoperative complications: SS subphenotype (p = 0.014), urgent surgical procedures (p = 0.039), and pre-existing ACS (p = 0.006). Subsequent propensity score analysis failed to identify any statistically significant factors. However, post-adjustment, the presence of preoperative transfusion was significantly associated with a threefold increased risk of experiencing a complication defined by the primary outcome (CO) (OR = 3; 95% CI: 1.09-8.25; p = 0.033).

Conclusion

In conclusion, preoperative red blood cell transfusion remains a critical aspect of perioperative management in adult SCD patients. We have demonstrated an association between preoperative transfusion and the occurrence of adverse outcomes, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), and admission to the intensive care unit (ICU) or mortality. Therefore, the preoperative transfusion strategy in adult sickle cell patients should be rationalized and personalized.

Auteurs

M. Mohib, E. Barruol, C. Riaud, M. Etienne Julan, A. Rollé

Orateur(s)

Mouna MOHIB (Abymes)