Peri-operative Blood Transfusion in Patients Undergoing Transurethral Resection of the Prostate in Kenyatta National Hospital

Abstract

Background: Transurethral resection of the prostate (TURP) is the most performed surgical procedures for Benign Prostate Enlargement (BPE) in Kenyatta National Hospital (KNH) in the urological unit. Even with the slightly invasive nature of the operation, blood loss is still the most common complication. In KNH, there is marked variation in the level of experience among surgeons performing the procedure and the incidence of blood transfusion is unknown. Factors associated with blood transfusion remain largely un-established. Study Objective: The study‟s core objective was to establish the practices of peri-operative transfusion in Transurethral resection of the prostate and its determinants. Study Design: A prospective observational study was undertaken. Patients and Methods: Using Systematic random sampling participants were recruited. The exposure variables for this study were patient's demographics, pre-operative Haemoglobin (Hb), size of the prostate, amount of blood loss. The main outcome variable was the occurrence of blood transfusion and the number of blood units transfused. Data was collected using a structured data sheet over a period of 9 months. Patients was followed up post operatively until discharge from the wards. Data Management and Analysis: SPSS (Chicago Illinois) software version 22 was used for data analysis. Descriptive statistics such as frequencies and percentages were used to describe demographic characteristics like age, occupation, and preoperative variables like prostate size , duration of resection, preoperative Hb and presence of UTI . Relationship between outcome variable, that is presence or absence of blood transfusion, and predictor variables were established by correlation analysis such as Fisher‟s exact test. Data was reported in percentages, proportions, and presented in pie charts and bar graphs. Results: 90 patients came into the study as recruits/participants. 21.1% of the patients were aged below 60 years while majority, 78.9% were aged above 60 years. The average pre-operative Hb was 13.27g/dl. Most of the patients had a post postoperative Hb of > 12g/dl. Patients who used 5 alpha reductase inhibitors were 77.8%. The mean prostate size taken for TURP was 72.26 grams. The median of the prostate size for TURP was 68.4 grams with a range of 31.6 -150 grams.The mean prostate size resected was 9.7 grams Patients who had urinary tract infections were 41.1%. 72.2% of patients had blood requested for TURP. 10% of patients received blood transfusion during TURP. 77.8% of the patients had clot retention post operatively while 80% of the

patients had persistent hematuria requiring irrigation for more than one day. Low preoperative Hemoglobin and increasing age were the most significant factors leading to blood transfusion. Conclusion:. The incidence of blood transfusion in this study was 10% which is comparable to the blood transfusion rate during TURP in modern centres. The main factors associated with blood transfusion in our study were increasing age, smoking and low preoperative Hemoglobin. Prostate size, urinary tract infection, duration of resection and surgeon‟s experience were not associated with increased risk for blood transfusion.