Perioperative blood transfusion increases risk of surgical site infection after bariatric surgery

Higgins, Rana M.; Helm, Melissa C.; Kindel, Tammy L.; Gould, Jon C.

doi:10.1016/j.soard.2019.01.023

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…In our study, a majority of patients developed postoperative surgical site infection. This may be attributed to the poor nutritional status of the patient due to underlying malignant disease, intraoperative blood transfusion, preoperative biliary stenting which are known to cause an increased incidence of surgical site infection [13,14]. Precautions against these factors have led to a decreasing trend of surgical site infection in our institute.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

Agrawal

Das

Sah

et al. 2021

J Gastrointest Canc

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BackgroundPancreaticoduodenectomy is a complex high risk surgical procedure usually done for malignant disease carrying signi cant postoperative morbidity and mortality. An audit and analysis of rate of postoperative morbidity and mortality and the impact of case volume can provide information about the lacunas in patient care and methods to improve it for safe and early discharge of patients. This study was conducted to nd out demographic pro le, the rate of perioperative morbidities, mortality and impact of case volume on patients undergoing pancreaticoduodenectomy for malignant disease which may serve as a guide to uplift the patient care in our center. MethodsRetrospective analysis of prospectively collected data of patients undergoing pancreaticoduodenectomy from 2015 to 2019 was performed. A total of 62 patients were included in the study. Patients clinicdemographic details, intraoperative and postoperative events were recorded. Rate of various postoperative morbidities and mortality and year wise trend of these factors were analyzed. ResultsMost of the patients were in sixth decade of life (38.7%) with male preponderance (61.3%). Pancreatic cancer was most commonly seen followed by cholangiocarcinoma (46.8%). SSI (32.3%), intraabdominal collection (25.8%), anastomotic leak (14.5%), pancreatic stula (22.6%), postpancreatectomy hemorrhage (8.1% ) were the major postoperative events. Mortality was found in 12.9% patients. ConclusionThere has been a decrease in rate of all these postoperative adverse events and improvement in the intraoperative blood loss and surgical duration with advancing years and increasing number of cases.

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Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

Agrawal

Das

Sah

et al. 2021

J Gastrointest Canc

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“…[32] The significant correlation of blood transfusion with risk of SSI is consistent to several studies. [33][34][35][36] On one hand need of blood transfusion indicates complex or maybe even uncontrolled intraoperative situation on the other hand immunosuppressive effects of blood transfusions are known. [34,37] Higher rates of SSI for patients with open surgical approach as well as previous laparotomy are likely explained due to association with increased surgical difficulty, more extended surgeries and higher risk of organ lesion.…”

Section: Discussionmentioning

confidence: 99%

No impact of sex on surgical site infections in abdominal surgery: A multi-center study

Zwicky

Gloor

Tschan

et al. 2022

Preprint

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Objective Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of sex on SSI in abdominal surgery under elimination of relevant confounders. Methods Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were assessed using univariate and multivariate analysis. Results In 649 of 6603 patients SSI was reported (9.8%). SSI was significantly associated with reoperation (22.7% vs. 3.4%, p <0.001), higher mortality rate (4.6% vs. 0.9%, p <0.001) and higher rate of length of hospital stay over the 75 th percentile (57.0% vs. 17.9%, p <0.001). In univariate analysis male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders’ such as comorbidities and perioperative factors there was no association between male sex and risk of SSI (odds ratio (OR) 1.1 [CI 0.8 – 1.4]). Independent risk factors for SSI in multivariate analysis were BMI >= 30 kg/m 2 (OR 1.8 [CI 1.3 - 2.3]), duration of surgery > 75 th percentile (OR 2.3 [1.8 - 2.9]), high contamination level (OR 1.3 [1.0 – 1.6]), laparotomy (OR 1.3 [1.0 – 1.7]), pervious laparotomy (OR 1.4 [1.1 – 1.7]), blood transfusion (OR 1.7 [1.2 – 2.4]), cancer (OR 1.3 [1.0-1.8], malnutrition (OR 2.5 [1.8 – 3.4]). Conclusion Under elimination of relevant confounders there is no significant correlation between sex and risk of SSI after abdominal surgery.

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“…The minimization or elimination of allogenic blood transfusions in the surgical setting is a highly desirable outcome. Receipt of allogenic blood was repeatedly shown to be strongly associated with postoperative mortality, ischemic complications including stroke, myocardial infarction, and renal impairment, prolonged hospital length of stay, and SSI [ 57 , 58 , 59 , 60 , 61 , 62 ]. Transfusion-related immunomodulation (TRIM) is an umbrella definition describing the phenomena of immune dysfunction attributed to the proinflammatory and immunosuppressive effects of packed red blood cell transfusion.…”

Section: Tranexamic Acid As An Agent To Mitigate Surgical Site Infectionmentioning

confidence: 99%

Plasmin, Immunity, and Surgical Site Infection

Hastings

Myles

Medcalf

2021

JCM

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SSI are a universal economic burden and increase individual patient morbidity and mortality. While antibiotic prophylaxis is the primary preventative intervention, these agents are not themselves benign and may be less effective in the context of emerging antibiotic resistant organisms. Exploration of novel therapies as an adjunct to antimicrobials is warranted. Plasmin and the plasminogen activating system has a complex role in immune function. The immunothrombotic role of plasmin is densely interwoven with the coagulation system and has a multitude of effects on the immune system constituents, which may not always be beneficial. Tranexamic acid is an antifibrinolytic agent which inhibits the conversion of plasminogen to plasmin. Clinical trials have demonstrated a reduction in surgical site infection in TXA exposed patients, however the mechanism and magnitude of this benefit is incompletely understood. This effect may be through the reduction of local wound haematoma, decreased allogenic blood transfusion or a direct immunomodulatory effect. Large scale randomised clinical trial are currently being undertaken to better explain this association. Importantly, TXA is a safe and widely available pharmacological agent which may have a role in the reduction of SSI.

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Perioperative blood transfusion increases risk of surgical site infection after bariatric surgery

Cited by 24 publications

References 20 publications

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center—Our Experience in Single Institute of Nepal

No impact of sex on surgical site infections in abdominal surgery: A multi-center study

Plasmin, Immunity, and Surgical Site Infection

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