Association Between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine Surgery

Fisahn, Christian; Jeyamohan, Shiveindra; Norvell, Daniel C; Tubbs, R. Shane; Moisi, Marc; Page, Jeni; Oskouian, Rod J.

doi:10.1097/bsd.0000000000000539

Cited by 40 publications

(40 citation statements)

References 11 publications

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“… 7 , 8 The risk of any infection was significantly associated with allogeneic blood transfusions, but again with a very low strength of evidence. 6 , 7 The significant association between all infections and allogeneic blood transfusions found by Fisahn et al 6 was in a study population of only 56 patients, the smallest population to yield significant results in our series. When examining individual infection risks (eg, SSI, UTI) the association lost significance.…”

Section: Discussionmentioning

confidence: 46%

“…These studies involved 8428 patients who received a transfusion and 43 242 who did not. They are composed of 6 retrospective cohort studies 5 – 10 and 5 retrospective case-control studies. 11 – 15 All studies have moderately high or high risk of bias, class of evidence (CoE) III or IV (see Supplemental Online Material for CoE evaluation).…”

Section: Resultsmentioning

confidence: 99%

“…With regard to surgical site infection (SSI), results from 10 low-quality studies are mixed; 3 studies report a significant association between allogeneic blood transfusion and infection, 7 , 8 , 10 4 report no significant association, 12 – 15 1 study describes an association within certain patient subgroups but not in others 5 and 2 do not report multivarariate analysis 6 , 11 ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Two low-quality studies assessed the association between allogeneic blood transfusion and any infection. Any infection is defined as an SSI, RTI, UTI, sepsis, and Clostridium difficile in one study by Fisahn et al, 6 and SSI, RTI, UTI, endocarditis, meningitis, and central venous line infection in a second study by Janssen et al 7 Pooling the studies result in a significant association, pooled odds ratio 2.6 (95% CI, 1.8-4.0) ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

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Blood Transfusion and Postoperative Infection in Spine Surgery: A Systematic Review

Fisahn

Schmidt

Schroeder

et al. 2018

Global Spine Journal

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Study Design:Systematic review.Objectives:Allogeneic blood transfusion-related immunomodulation may relatively suppress the immune system, heightening the risk of infection following spine surgery. This systematic review seeks to determine whether allogeneic blood transfusion increases the risk of postoperative infection and whether there are any factors that modify this association.Methods:PubMed, Cochrane Central Register of Controlled Trials, and reference lists from included studies were searched from inception to April 20, 2017 to identify studies examining the risk of infection following allogeneic blood transfusion in adult patients receiving surgery for degenerative spine disease.Results:Eleven retrospective cohort or case-control studies, involving 8428 transfusion patients and 43 242 nontransfusion patients, were identified as meeting the inclusion criteria. Regarding surgical site infection (SSI), the results were mixed with roughly half reporting a significant association. There was an association between allogeneic transfusion and urinary tract infection (UTI) and any infection, but not respiratory tract infection. There was no statistical modifying effect of lumbar versus thoracic surgery on the association of allogeneic transfusion and SSI, though subgroup analyses in 3 of 4 studies reported a statistical association between transfusion and postoperative infections, including SSI, UTI, and any infection within the lumbar spine.Conclusions:This systematic review failed to find a consistent association between allogeneic transfusion and postoperative infection in spine surgery patients. However, these studies were all retrospective with a high or moderately high risk of bias. To properly examine this association an observational prospective study of sufficient power, estimated as 2400 patients, is required.

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Section: Discussionmentioning

confidence: 46%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Blood Transfusion and Postoperative Infection in Spine Surgery: A Systematic Review

Fisahn

Schmidt

Schroeder

et al. 2018

Global Spine Journal

Self Cite

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“…26,42 The need for blood transfusions to compensate for these losses is associated with perioperative complications such as infections, thromboembolic events, and hemolytic transfusion reactions. 8,12,13,19,20,33,34,39,41,46 Also, patients requiring blood transfusion have been shown to have prolonged hospitalization, increased readmission and reoperation rates, and higher surgery-related costs. 12,22,29,34 Because of these various complications, there have been significant efforts to reduce the need for perioperative blood product transfusions.…”

Section: Discussionmentioning

confidence: 99%

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

Buell¹,

Taylor²,

Chen³

et al. 2019

Neurosurgical Focus

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OBJECTIVESignificant blood loss and coagulopathy are often encountered during adult spinal deformity (ASD) surgery, and the optimal intraoperative transfusion algorithm is debatable. Rotational thromboelastometry (ROTEM), a functional viscoelastometric method for real-time hemostasis testing, may allow early identification of coagulopathy and improve transfusion practices. The objective of this study was to investigate the effect of ROTEM-guided blood product management on perioperative blood loss and transfusion requirements in ASD patients undergoing correction with pedicle subtraction osteotomy (PSO).METHODSThe authors retrospectively reviewed patients with ASD who underwent single-level lumbar PSO at the University of Virginia Health System. All patients who received ROTEM-guided blood product transfusion between 2015 and 2017 were matched in a 1:1 ratio to a historical cohort treated using conventional laboratory testing (control group). Co-primary outcomes were intraoperative estimated blood loss (EBL) and total blood product transfusion volume. Secondary outcomes were perioperative transfusion requirements and postoperative subfascial drain output.RESULTSThe matched groups (ROTEM and control) comprised 17 patients each. Comparison of matched group baseline characteristics demonstrated differences in female sex and total intraoperative dose of intravenous tranexamic acid (TXA). Although EBL was comparable between ROTEM versus control (3200.00 ± 2106.24 ml vs 3874.12 ± 2224.22 ml, p = 0.36), there was a small to medium effect size (Cohen’s d = 0.31) on EBL reduction with ROTEM. The ROTEM group had less total blood product transfusion volume (1624.18 ± 1774.79 ml vs 2810.88 ± 1847.46 ml, p = 0.02), and the effect size was medium to large (Cohen’s d = 0.66). This difference was no longer significant after adjusting for TXA (β = −0.18, 95% confidence interval [CI] −1995.78 to 671.64, p = 0.32). More cryoprecipitate and less fresh frozen plasma (FFP) were transfused in the ROTEM group patients (cryoprecipitate units: 1.24 ± 1.20 vs 0.53 ± 1.01, p = 0.03; FFP volume: 119.76 ± 230.82 ml vs 673.06 ± 627.08 ml, p < 0.01), and this remained significant after adjusting for TXA (cryoprecipitate units: β = 0.39, 95% CI 0.05 to 1.73, p = 0.04; FFP volume: β = −0.41, 95% CI −772.55 to −76.30, p = 0.02). Drain output was lower in the ROTEM group and remained significant after adjusting for TXA.CONCLUSIONSFor ASD patients treated using lumbar PSO, more cryoprecipitate and less FFP were transfused in the ROTEM group compared to the control group. These preliminary findings suggest ROTEM-guided therapy may allow early identification of hypofibrinogenemia, and aggressive management of this may reduce blood loss and total blood product transfusion volume. Additional prospective studies of larger cohorts are warranted to identify the appropriate subset of ASD patients who may benefit from intraoperative ROTEM analysis.

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A Biofilm-Based Approach to the Diagnosis and Management of Postoperative Spine Infection

Shaw

2019

Targeting Biofilms in Translational Research, Device Development, and Industrial Sectors

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Association Between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine Surgery

Abstract: Level 3.

Cited by 40 publications

References 11 publications

Blood Transfusion and Postoperative Infection in Spine Surgery: A Systematic Review

Blood Transfusion and Postoperative Infection in Spine Surgery: A Systematic Review

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

A Biofilm-Based Approach to the Diagnosis and Management of Postoperative Spine Infection

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