ReviewBlood Transfusion and Infection After Cardiac Surgery
Section snippets
Study Design and Patients
This observational study of postoperative infections among adults undergoing cardiac surgery at 10 centers in the United States and Canada was funded by the National Institutes of Health and Canadian Institutes of Health Research. Its overall objective was to identify management practices associated with risk for infections. Inclusion criteria were a clinical indication for a cardiac surgical intervention and age 18 years or older. Patients with active systemic infection at enrollment (most
Infections After Cardiac Surgery
Overall, 5,158 patients experienced 298 major infections (5.8%). The most commonly occurring major infections were pneumonia, C difficile colitis, and bloodstream infections. Surgical site infections were uncommon (Table 2). More than 40% of major infections occurred after hospital discharge.
Prevalence of Transfusion
Overall, 2,481 patients (48%) received at least 1 unit RBC, with close to half of transfused patients receiving 1 or 2 units (48%). Although percentage of patients transfused ranged from 33% to 74%,
Principal Findings
This unique contemporary multiinstitutional study of infections occurring up to 65 days after a variety of cardiac surgical operations, with well-adjudicated events, revealed that RBC transfusion, particularly postoperative transfusion, was strongly associated with major postoperative infections in a dose-related fashion. Use of platelets appeared to have a mitigating effect, especially for patients receiving higher numbers of RBC units. The association between RBC transfusion and infection was
References (41)
Transfusion and outcome in heart surgery
Ann Thorac Surg
(2002)- et al.
Perioperative blood transfusion associated with infectious complications after colorectal cancer operations
Am J Surg
(1986) - et al.
2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines
Ann Thorac Surg
(2011) - et al.
Implications and management of anemia in cardiac surgery: current state of knowledge
J Thorac Cardiovasc Surg
(2012) - et al.
Update on blood conservation for cardiac surgery
J Cardiothorac Vasc Anesth
(2012) Platelet transfusion and adverse outcomes
Lancet
(2004)- et al.
Association of bacterial infection and red blood cell transfusion after coronary artery bypass surgery
Ann Thorac Surg
(2002) - et al.
Transfusion increases the risk of postoperative infection after cardiovascular surgery
J Am Coll Surg
(2006) - et al.
Allogenic blood transfusion does not predispose to infection after cardiac surgery
Ann Thorac Surg
(2004) - et al.
Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality
Transfus Med Rev
(2010)
Transfusion and pulmonary morbidity after cardiac surgery
Ann Thorac Surg
Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery
Chest
Iron overload following red blood cell transfusion and its impact on disease severity
Biochim Biophys Acta
Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation
Blood
Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron
Blood
Effect of blood transfusion on long-term survival after cardiac operation
Ann Thorac Surg
Transfusion in coronary artery bypass grafting is associated with reduced long-term survival
Ann Thorac Surg
The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective?
Ann Thorac Surg
Vacuum-assisted venous return reduces blood usage
J Thorac Cardiovasc Surg
Comprehensive multimodality blood conservation: 100 consecutive CABG operations without transfusion
Ann Thorac Surg
Cited by (232)
Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis
2024, Annals of Thoracic SurgeryDevelopment and validation of a machine learning prediction model for perioperative red blood cell transfusions in cardiac surgery
2024, International Journal of Medical InformaticsLow-Volume Acute Normovolemic Hemodilution Does Not Reduce Allogeneic Red Blood Cell Transfusion in Cardiac Surgery in the Modern Era of Patient Blood Management: A Propensity Score-Matched Cohort Study
2024, Journal of Cardiothoracic and Vascular AnesthesiaThe Relationship Between Transfusion in Cardiac Surgery Patients and Adverse Outcomes
2024, Journal of Cardiothoracic and Vascular AnesthesiaWhat drives variability in postoperative cardiac surgery transfusion rates?
2024, Journal of Thoracic and Cardiovascular SurgeryTransfusion of non–red blood cell blood products does not reduce survival following cardiac surgery
2024, Journal of Thoracic and Cardiovascular Surgery