title: Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients.
abstract: BACKGROUND
  Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results.
  
  
  OBJECTIVE
  To investigate whether homologous blood transfusions significantly affect postoperative septic morbidity and mortality in patients undergoing elective surgery for gastric cancer.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Hospitalized care.
  
  
  METHODS
  The hospital records of 209 patients who underwent elective surgery for gastric cancer at the Department of Surgery of the Hospital del Mar, Autonomous University of Barcelona in Spain, and at the Department of Surgery of the Catholic University of Rome in Italy from April 1984 to December 1990 were reviewed, and 179 patients were included in the study.
  
  
  METHODS
  The following variables were entered into univariate and multivariate analyses to identify factors potentially affecting postoperative septic morbidity: demographic data, weight loss, preoperative serum albumin level and lymphocyte count, type and duration of operative procedure, amount and timing of blood transfusion, and stage of disease.
  
  
  RESULTS
  Univariate analysis showed that a large quantity of blood transfused (> 1500 mL) and transfusion in the postoperative period (group C) were associated with a worse clinical outcome. Postoperative transfusion was an independent predictor of septic morbidity in multivariate analysis.
  
  
  CONCLUSIONS
  Despite transfusion-induced immunomodulation, homologous blood transfusion should not be considered a risk factor for postoperative septic morbidity in patients undergoing elective major abdominal surgery. The timing-response relationship between transfusions and septic morbidity in multivariate analysis may be the effect of uncontrolled confounders such as variation of volemia induced by stress response in patients who were developing or had just developed infectious complications.
authors.affiliation: Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bellantone
authors.forename: A
authors.initials: A
authors.lastname: Sitges-Serra
authors.forename: M
authors.initials: M
authors.lastname: Bossola
authors.forename: G B
authors.initials: GB
authors.lastname: Doglietto
authors.forename: M
authors.initials: M
authors.lastname: Malerba
authors.forename: G
authors.initials: G
authors.lastname: Franch
authors.forename: F
authors.initials: F
authors.lastname: Pacelli
authors.forename: F
authors.initials: F
authors.lastname: Crucitti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D065227:Transfusion Reaction