Document Detail

Transfusion increases the risk of postoperative infection after cardiovascular surgery.
MedLine Citation:
PMID:  16377506     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because of the immunomodulatory effects of transfusion, we attempted to identify factors associated with blood product use and determine the association of transfusion quantity with postoperative infection. STUDY DESIGN: We studied total perioperative transfusion of blood products for 15,592 cardiovascular operations performed from July 1998 to May 2003. Infection end points were septicemia/bacteremia (n=351, 2.2%) and superficial (n=353, 2.3%) and deep (n=212, 1.4%) sternal wound infections. Factors associated with blood product administration were used to form balancing scores to adjust for differences in patient characteristics among those receiving and not receiving blood products. RESULTS: Fifty-five percent of patients received packed red blood cells (RBC), 21% received platelets, 13% got fresh frozen plasma (FFP), and 3% got cryoprecipitate. Factors associated with RBC use included older age, female gender, higher New York Heart Association class, lower hematocrit, reoperation, and longer cardiopulmonary bypass time--all indicative of higher-risk patients. The more RBC units transfused, the higher was the occurrence of septicemia/bacteremia (p < 0.0001) and superficial (p=0.0007) and deep (p < 0.0001) sternal wound infection. Use of FFP (septicemia/bacteremia) and platelets (septicemia/bacteremia and deep sternal wound infection) mitigated against this association only slightly. CONCLUSIONS: Blood products tended to be used in the sickest patients. But after accounting for this, risk of infection increased incrementally with each unit of blood transfused. Although cause and effect cannot be established, results suggested that blood product transfusion is an independent risk factor for postoperative infection in cardiac surgical patients, blood products are more likely to be used in the sickest patients, and no amount of blood loss treated by transfusion is innocuous.
Michael K Banbury; Mariano E Brizzio; Jeevanantham Rajeswaran; Bruce W Lytle; Eugene H Blackstone
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Publication Detail:
Type:  Journal Article     Date:  2005-11-10
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  202     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-02-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  131-8     Citation Subset:  AIM; IM    
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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MeSH Terms
Bacteremia / etiology*
Blood Component Transfusion / utilization*
Cardiac Surgical Procedures*
Heart Diseases / complications,  surgery
Middle Aged
Plasma Exchange / utilization*
Retrospective Studies
Risk Factors
Surgical Wound Infection / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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