Transfusion Increases the Risk of Postoperative Infection after Cardiovascular Surgery

Banbury, Michael K.; Brizzio, Mariano E.; Rajeswaran, Jeevanantham; Lytle, Bruce W.; Blackstone, Eugene H.

doi:10.1016/j.jamcollsurg.2005.08.028

Cited by 217 publications

(153 citation statements)

References 29 publications

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“…As the two studies mentioned before, Banbury et al [81] and Sreeram et al [82] found an increased rate of infections in cardiac surgical patients receiving RBC transfusions.…”

Section: Clinical Studies On Transfusion-related Immunomodulationmentioning

confidence: 74%

Transfusion-transmissible infections and transfusion-related immunomodulation

Buddeberg

Schimmer

Spahn

2008

Best Practice & Research Clinical Anaesthesiology

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Transfusion-transmissible infections and transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. Despite new standards in the manufacture and storage of blood products, bacterial contamination still remains a considerable cause of transfusion-related morbidity and mortality. Better allograft survival in kidney transplant patients and higher cancer recurrence rate in surgical oncology patients after allogeneic blood transfusions highlighted a previously underestimated side-effect: transfusion-related immunomodulation (TRIM). The precise pathomechanism still remains uncertain; however, its mostly deleterious effects--such as a higher incidence of postoperative or nosocomial infections--is increasingly accepted. Although transfusion-related immunomodulation is thought to be mediated mainly by donor white blood cells, the benefit of leukoreduction on overall mortality and on infectious complications is highly debatable. Transfusion-transmissible infections and Transfusion-related immunomodulation Transfusion-transmissible infections and Transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years.

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“…As the two studies mentioned before, Banbury et al [81] and Sreeram et al [82] found an increased rate of infections in cardiac surgical patients receiving RBC transfusions.…”

Section: Clinical Studies On Transfusion-related Immunomodulationmentioning

confidence: 74%

Transfusion-transmissible infections and transfusion-related immunomodulation

Buddeberg

Schimmer

Spahn

2008

Best Practice & Research Clinical Anaesthesiology

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“…Our results also showed a strong positive association between smoking and perioperative transfusions. Transfusions also are hypothesized to have immunomodulating effects that increase the risk of surgical site infections, and they carry the added risk of blood-borne infections [4,12,21,29]. Research has shown that one unit of transfused blood is associated with increased risk of wound complications, postoperative infections, renal dysfunction, pulmonary complications, systemic sepsis, composite morbidity, and postoperative length of stay [16].…”

Section: Discussionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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“…Factors related to a higher need of blood products use include: elderly patients, female, high functional class (New York Heart Association), low Ht, reoperation, and high CPB time [3]. Precautions such as a careful investigation of family bleeding history and adequate laboratory assessment (PT, aPTT, platelets, TT, TS, and fibrinogen) contribute to prevent the occurrence of bleeding during CPB [19].…”

Section: Preoperative Strategiesmentioning

confidence: 99%

“…The use of blood components is an independent risk factor for postoperative infection [3]. The use of cardiopulmonary bypass (CBP) can increase postoperative bleeding [4], contributing to the need of blood components.…”

Section: Introductionmentioning

confidence: 99%