Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

Abstract

Objective: Primary outcome was the risk for infections after cell salvage in cardiac surgery. Design: Data of a randomized controlled trial on cell salvage and filter use (ISRCTN58333401). Setting: Six cardiac surgery centers in the Netherlands. Participants: All 716 patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures over a 4-year period who completed the trial. Interventions: Postoperative infection data were assessed according to Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions. Measurements and Main Results: Fifty-eight (15.9%) patients with cell salvage had infections, compared with 46 (13.1%) control patients. Mediation analysis was performed to estimate the direct effect of cell salvage on infections (OR 2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic transfusion and processed cell salvage blood on infections. Correction for confounders, including age, seks and body mass index was performed. Allogeneic transfusion had a direct effect on infections (OR = 2.082 [1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR = 0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p < 0.001), but a negative direct effect of processed cell salvage blood (1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there was a positive direct effect of cell salvage on the amount of processed blood. Conclusions: Cell salvage was directly associated with higher infection rates, but this direct effect was almost completely eliminated by its indirect protective effect through reduced allogeneic blood transfusion.

Toll-like receptor polymorphisms (TLR2 and TLR4) association with the risk of infectious complications in cardiac surgery patients

“…Our thesis was indirectly confirmed by the fact that there was no need for VAC therapy in patients with surgical site infections. On the other hand, the reported prevalence of hospital-acquired infections is similar to the results of research conducted by van Klarenbosch et al in 2020, 16 which was reported to be 14.5%. The similarities in both studies can be attributed to several factors such as BMI, ESlog, transfusions requirements, and CPB time.…”

More Is Not Always Better: Effects of Cell Salvage in Cardiac Surgery on Postoperative Fibrinogen Concentrations

“…Recently, a retrospective analysis in cardiac surgery suggested that cell salvage during cardiac surgery might increase the risk of postoperative infections. 7 In noncardiac surgery, a prospective cohort study suggested that the use of a postoperative cell-salvage and reinfusion system increased postoperative hemoglobin values, but it was associated with potentially life-threating side effects including hypotension and hypoxia. 8 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Son et al present an ex vivo dilution study investigating the effect of reinfused salvage blood during cardiac surgery on the patient's coagulation function.…”

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

“…Manuel detected Gram-positive bacteria, primarily Staphylococcus epidermidis , in sRBCs samples collected from shed blood following washing with Cell Saver (CS) machines in patients undergoing cardiac surgery ( 5 ). They further observed higher rates of postoperative infections in patients that underwent cardiac surgery with ICS as compared to cardiac surgery patients for whom salvage was not performed ( 6 ). Even so, a meta-analysis of over 4,000 patients found ICS to be associated with a 28.7% reduction in the overall risk of infective morbidity ( 7 ).…”