Blood loss and transfusion during open femur fracture surgeries at moi teaching and referral hospital, eldoret, Kenya

Abstract

Fractures of the femur due to increased road traffic accidents are on the rise and lead among orthopedic trauma conditions at Moi Teaching and Referral Hospital (MTRH). The best treatment is open surgery with fixation and stabilization using implants, mostly because fractures are either old or due to lack of equipment for closed or percutaneous surgery, leading to blood loss necessitating transfusion. MTRH experiences excessive blood cross-match relative to actual transfusion, wasting reagents and blood. There is a paucity of publications on factors associated with blood loss and the transfusion pattern in open femur fracture surgeries.The main objective was to determine factors affecting blood loss and transfusion during open femoral fracture surgeries at MTRH, Eldoret. A cross sectional study conducted at MTRH on adult patients undergoing open femur fracture surgeries between February 2022 and January 2023 on a sample of 172 patients using interviewer administered pretested structured questionnaire. The results showed that the Age range: 18-92 years, mean 47.3 ±20.3 years, majority male (71.5%). Blood loss: 45- 3960 mL, mean 1274.1 ±714 mL. Cross-matched all, but only 19.8% transfused (CTR: 6.7:1). BTR: 19.8%, mostly 2 units. Transfusion reasons: visual estimation (58.8%), low hemoglobin (41.2%). AO fracture 31: 51.7%. IM SIGN nail: 37.2%, PFNA: 33.1%. Spinal anesthesia: 82.6%, diathermy in all. Consultants led 83.7%, registrars 5.2%. Surgeries: >2 hours (41.9%), incision 15- 25 cm (69.8%). This concludes that blood loss was high, with excessive cross-matching and wastage of blood indicated by a high CTR, while transfusion rates were low and primarily determined by anaesthetists’ visual estimation. Factors contributing to blood loss included timing of surgery, fracture complexity, and surgery duration. From the study, prompt surgery to minimize blood loss, anticipation of significant blood loss in complex cases, selective cross-matching, transfusion only for patients with low haemoglobin levels, and early identification and mitigation of factors contributing to blood loss and transfusion.