Blood transfusion and infection after cardiac surgery.

Abstract

Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. The most common procedures were isolated coronary artery bypass graft surgery (31%) and isolated valve surgery (30%); 19% were reoperations. Infections were adjudicated by independent infectious disease experts. Multivariable Cox modeling was used to assess the independent effect of blood and platelet transfusions on major infections within 60 ± 5 days of surgery. Red blood cells (RBC) and platelets were transfused in 48% and 31% of patients, respectively. Each RBC unit transfused was associated with a 29% increase in crude risk of major infection (p < 0.001). Among RBC recipients, the most common infections were pneumonia (3.6%) and bloodstream infections (2%). Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.

• Authors: Keith A Horvath, Michael A Acker, Helena Chang, Emilia Bagiella, Peter K Smith, Alexander Iribarne, Irving L Kron, Pamela Lackner, Michael Argenziano, Deborah D Ascheim, Annetine C Gelijns, Robert E Michler, Danielle Van Patten, John D Puskas, Karen O'Sullivan, Dorothy Kliniewski, Neal O Jeffries, Patrick T O'Gara, Alan J Moskowitz, Eugene H Blackstone
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 95 Issue 6 Pg. 2194-201 (Jun 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23647857 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Review)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Age Factors
• Aged
• Bacterial Infections (epidemiology, etiology, physiopathology)
• Blood Transfusion (methods)
• Cardiac Surgical Procedures (adverse effects, methods)
• Cohort Studies
• Erythrocyte Transfusion (adverse effects, methods)
• Female
• Hospital Mortality (trends)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Platelet Transfusion (adverse effects, methods)
• Postoperative Complications (epidemiology, etiology, physiopathology)
• Proportional Hazards Models
• Reference Values
• Retrospective Studies
• Risk Assessment
• Sex Factors
• Survival Analysis
• Transfusion Reaction
• Treatment Outcome