Modalities of Blood Sparing in Orthopedic and Trauma Surgery at the Centre Hospitalier Universitaire La Renaissance in Chad

Abstract

Objective: To determine intraoperative blood-sparing strategies in major orthopedic and trauma surgery at CHU-R.
Patients and methods: This was a cross-sectional, descriptive study conducted over a thirteen (13)-month period from November 2022 to December 2023 in the operating theatre. All patients who had given their consent for major orthopaedic or traumatological surgery were included in the study. Variables were sociodemographic, clinical, paraclinical, therapeutic and evolutionary.
Results: A total of 105 patients were enrolled, 76.2% of them male, with a sex ratio of 3.1. The mean age was 55 years, with predominance in the [21-25] and [51-55] age groups, 11.40% (n=12) and 12.40% (n=13). Two-thirds (71.40%) of surgeries were trauma surgeries. PTH and Gamma nailing were respectively the most common types of major orthopedic (42%) and traumatological (41%) surgery. Haemostasis disorders were detected in 21.90% of cases (TP≤.70 and APTT<24) and 82% of patients had intraoperative blood loss ≥1000 including 28% between 1501 and 2000ml. Tranexamic acid was used in 57 patients (54.29%) and 15.24% of patients who did not receive tranexamic acid had blood loss ≥ 1000ml. The use of an electric scalpel and tourniquet helped reduce intraoperative blood loss (5.80% versus 63%). Other strategies such as anesthesia and surgical techniques did not show a significant difference in intraoperative blood loss. Clinical tolerance of anemia was 86.67%. Five patients were transfused intraoperatively.
Conclusion: this study is part of the evaluation of blood-sparing practices in orthopaedic and traumatological surgery. ATX had demonstrated significant efficacy in intraoperative blood conservation.