Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions

Abstract

Homologous blood transfusions have been associated in both animals and humans with an increased risk of acute postoperative infectious complications. Eighty-four patients who underwent hip replacement surgery and were transfused with 2 or 3 units of blood were analyzed to determine whether those receiving homologous transfusions had different outcomes than those receiving autologous blood only. Only patients free of other risks for postoperative infection were studied. Those receiving homologous blood had a 32 percent (16/50) rate of proven or suspected infections, which was significantly higher than the 3 percent (1/34) rate in patients receiving autologous blood (p = 0.0029). Wound infections accounted for only a minority (6/17) of the proven or suspected infections, which suggests that nonsurgical factors contributed to these complications. The patients identified as being infected required significantly more antibiotic therapy (mean, 7.6 days) and lengthier hospital stays (mean, 15.5 days) than the patients who remained free of evidence of infection (means: 2.3 days of antibiotics and 12.3 days in the hospital) (p = 0.0001 for each variable). Other potential risk factors for infection, such as duration of surgical procedure, advanced patient age, amount of blood loss, type of anesthesia, surgeon performing the operation, use of a cemented versus porous-coat prosthesis, leukocytopenia, anemia, and underlying medical diagnosis, did not account for the differences in infection rates seen in those receiving homologous and autologous transfusions. These results confirm previous reports of an increased risk of postoperative infection in patients receiving homologous transfusions. Homologous transfusion may contribute to an increased risk of infection by immunologic modulation of the recipient.(ABSTRACT TRUNCATED AT 250 WORDS)

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

“…It was also noted that each transfused patient stayed in the hospital for one additional day. Similar observations were made in other studies [4,16]. The exact mechanism that results in higher rates of febrile episodes and wound problems after homologous transfusion has yet to be determined, but it seems that these problems can be reduced by avoiding the use of bank blood [6,7,10,24].…”

An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

“…Apart from well-known risks, such as the transmission of infections or transfusion reactions, there is concern-especially in orthopedic surgery-about a causal relationship between allogenic red blood cell transfusions and immunomodulation. Transfusion-related immunosuppression is thought to increase the incidence of postoperative infections, delay healing of postoperative wounds and thereby prolong hospitalization (Murphy et al 1991, Blumberg 1997, Bierbaum et al 1999, Innerhofer et al 1999, Borghi and Casati 2000. In our prospective study-which included 975 major orthopedic surgical procedures, such as total hip arthroplasty and knee replacement surgery, fusion surgery of the lumbar, thoracic or cervical spine-we confirm this view (Table 1).…”

Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

“…Allogenic blood transfusion may prolong the duration of hospital stays 5 and may adversely affect the outcomes of surgical patients by increasing the risk of surgical site infection and periprosthetic joint infection 6,7 . Therefore, great effort has been made to reduce the rate of allogenic blood transfusion by implementing various blood conservation strategies to reduce perioperative blood loss 4 .…”