Allogeneic Blood Transfusion Increases the Risk of Postoperative Bacterial Infection: A Meta-analysis

Hill, Gary E.; Frawley, William H.; Griffith, Karl E.; Forestner, John E.; Minei, Joseph P.

doi:10.1097/01.ta.0000022460.21283.53

Cited by 480 publications

(292 citation statements)

References 39 publications

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“…22 Consistent with this theory, 40% of the massive transfusion patients in the NSQIP registry developed infections, and 25% developed systemic infectious complications, including systemic inflammatory response syndrome, sepsis, and septic shock. Our results are also consistent with those of Hill et al 21 who examined the relationship between transfusion and infections in a meta-analysis and found that transfusions more than triple the risk of systemic postoperative infection. Furthermore, results in trauma patients are similar to our results, with transfusions substantially increasing systemic infection risk and more than doubling mortality.…”

Section: Discussionsupporting

confidence: 93%

“…For example, blood transfusions might be associated with increased risk of cancer recurrence and bacterial infections. 21 Leukocyte-mediated immunosuppressive effects of transfusions may contribute to the increased risk of infection. 22 Consistent with this theory, 40% of the massive transfusion patients in the NSQIP registry developed infections, and 25% developed systemic infectious complications, including systemic inflammatory response syndrome, sepsis, and septic shock.…”

Section: Discussionmentioning

confidence: 99%

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Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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Background Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality.Methods We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. Results The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (C 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma [ 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. Conclusion Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units. RésuméContexte Les transfusions massives sont associées à des taux élevés de morbidité et de mortalité; toutefois, les Presented in part at the Foundation for Anesthesia Education and Research session at the

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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“…Risks associated with homologous transfusion include transfusion reactions, acquisition of a blood-borne pathogen, and transfusionrelated immune suppression. 3 However, bleeding may also affect other outcome measures, in the event that bleeding obscures the operative field, preventing adequate visualization by the surgeon, possibly preventing him from fully excising the tumor. Alternatively, excessive blood loss may inspire the surgeon to operate more quickly, potentially to the detriment of cancer control.…”

Section: Introductionmentioning

confidence: 99%

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Lloyd

Bañez

Aronson

et al. 2009

Prostate Cancer Prostatic Dis

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The literature contains conflicting data on preoperative predictors of estimated blood loss (EBL) at radical retropubic prostatectomy (RRP). We sought to examine preoperative predictors of EBL at the time of RRP among patients from the SEARCH database to lend clarity to this issue. A total of 1154 patients were identified in the SEARCH database who underwent RRP between 1988 and 2008 and had EBL data available. We examined multiple preoperative factors for their ability to predict EBL using multivariate linear regression analysis. Median EBL was 900 ml (s.d. 1032). The 25th and 75th percentile for EBL were 600 and 1500 ml, respectively. EBL increased significantly with increasing body mass index (BMI) and increasing prostate size and decreased with more recent year of RRP (all Po0.001). The mean-adjusted EBL in normal-weight men (BMIo25 kg/m 2 ) was 807 ml compared to 1067 ml among severely obese men (BMIX35 kg/m 2 ). Predicted EBL for men with the smallest prostates (o20 g) was 721 ml, compared to 1326 ml for men with prostates X100 g. Finally, statistically significant differences between centers were observed, with mean-adjusted EBL ranging from 844 to 1094 ml. Both BMI and prostate size are predictors of increased EBL. Prostate size is of particular note, as a nearly twofold increased EBL was seen from the smallest (o20 g) to the largest prostates (X100 g). Over time, average EBL significantly decreased. Finally, significant differences in EBL were observed between centers. Patients with multiple risk factors should be forewarned they are at increased risk for higher EBL, which may translate into a greater need for blood transfusion.

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“…Sin embargo, los niveles bajos pretrasplante de hemoglobina pueden constituir un indicador de inmunocompetencia reducida. Nuestro estudio, al igual que otros (23)(24)(25)(26), demuestra que el consumo intraoperatorio de hemoderivados predice el riesgo de infecciones bacterianas postoperatorias. Miki y cols.…”

Section: Discussionunclassified

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

Rodríguez‐Ariza¹,

Monrobel

Martı́nez-Galisteo³

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNEl trasplante hepático ortotópico (THO) es el tratamiento de elección para enfermedades hepáticas agudas o crónicas en estadio final. Sin embargo, el seguimiento de Factores pronósticos de complicaciones postoperatorias en el trasplante hepáticoA. Rodríguez-Ariza, A. Monrobel, E. Martínez-Galisteo 1 , C. Alicia Padilla 1 , J. A. Bárcena 1 , E. Fraga, G. Costán, P. Barrera, A. Poyato, J. L. Montero, P. López-Cillero 2 , J. Muntané y M. de la Mata RESUMENObjetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO) se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo.Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias.Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas.Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO. ABSTRACTObjectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT) is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity and mortality in patients undergoing OLT. The purpose of the present study was the identification of factors related to the different postoperative complications after OLT. Experimental design: a prospective study was carried out.Patients: seventy-eight variables were analyzed in 32 consecutive patients undergoing OLT. The factors independently associated with the appearance of postoperative complications were identified using a stepwise logistic regression analysis.Results: the multivariate analysis showed that malondialdehyde and creatinine pretransplant serum levels were associated with the development of renal dysfunction. T...

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Allogeneic Blood Transfusion Increases the Risk of Postoperative Bacterial Infection: A Meta-analysis

Cited by 480 publications

References 39 publications

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

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