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Blood Transfusion and Infection After Cardiac Surgery

Presented at the Late-Breaking Clinical Trial Abstract Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.11.078Get rights and content

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.

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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

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