PURPOSE: Decisions regarding perioperative blood transfusions are subject to clinical and laboratory factors. Blood transfusions are associated with increased risk of infection, sepsis, organ failure, and length of stay. Current guidelines on transfusions are based on elective settings. There is a paucity of data on blood transfusion use in emergency surgery. This study reviews the appropriateness of blood transfusions in patients undergoing emergency general surgical laparotomies. METHODS: Patients undergoing emergency general surgical laparotomies at Peninsula Health from January 2013 to May 2015 were reviewed. Hemoglobin (Hb) levels triggering transfusion and overall blood utilization were obtained. Transfusions were classified based on whether they were given pre-, intra- or postoperatively. Transfusions with Hb >80 g/L in the absence of bleeding or preoperative anemia were deemed ‘inappropriate’ as per Australian Blood Authority guidelines. RESULTS: Over the 29-month period, 368 patients underwent 398 emergency laparotomies. Blood transfusions were given to 102 patients (27.7%). These patients required 240 transfusion episodes. Patients were given a median of three units of blood. One hundred and sixty-six transfusions (69.2%) were postoperative. Forty-six transfusions (19.2%) were given with Hb >80 g/L in the absence of other indications, and were deemed inappropriate. Inappropriate transfusions occurred more frequently on the ward compared to ICU (p<0.05). Almost two thirds of inappropriate transfusions were given for Hb 80~85 g/L. CONCLUSION: Nearly one in five patients received an inappropriate transfusion. More judicious use of blood products in emergency patients is required, especially on surgical wards.
Anemia ; Blood Transfusion* ; Emergencies* ; Hemorrhage ; Humans ; Laparotomy* ; Length of Stay ; Postoperative Complications ; Sepsis

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.