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

Abstract

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.

Risk Factors and Prevention of Surgical Site Infections Following Spinal Procedures

“…34 Finally, there is limited and conflicting evidence to suggest that blood transfusions may increase SSI rates. 34 -37…”

“…34 Finally, there is limited and conflicting evidence to suggest that blood transfusions may increase SSI rates. [34][35][36][37] Procedural-Related Measures to Reduce SSIs Preoperative Antibiotics. The use of prophylactic antibiotics has been established to decrease the chance of an SSI, with efficacy related to the timing of administration.…”

Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

“…Another potential risk factor identified in our study is the increased risk of intra-and postoperative bleeding requiring transfusion in LE cases (OR 4.643, 95% CI: 3.048-7.060). Journal of Oncology Although the association between perioperative blood transfusions and postoperative infections is still under scrutiny, there is some evidence to suggest that immunomodulation after allogenic blood transfusion increases the patient's susceptibility to infection [30,31]. is is particularly concerning in patients with malignancy who are already in an immunocompromised state.…”

Anaesthetic management of craniosynostosis repair – A retrospective study

“…Consistent with the findings of Christian et al ., we too failed to find a significant association between the volume of blood transfused and the risk of wound infection. [ 10 ]…”