Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients.
BACKGROUND
Allogeneic blood transfusions have been reported to increase susceptibility to postoperative infection, but the findings were inconclusive. This study was designed to investigate the effect of buffy coat-depleted allogeneic and autologous transfusion on postoperative infection in patients undergoing orthopedic surgery.


METHODS
Patients (n = 385) undergoing elective orthopedic surgery (primary and revision joint replacement, spinal, or pelvic surgery) were included in a prospective observational study of the incidence of postoperative infection between April and December 1996. Infection rates in patients who received allogeneic buffy coat-depleted blood transfusions were compared with those in patients who received no transfusion or only autologous (buffy coat-depleted) blood.


RESULTS
Patients without exposure to allogeneic blood (no blood or only autologous blood) had an infection rate of 3.9 percent, as compared to a rate of 12.2 percent for those with exposure to allogeneic blood (allogeneic blood, autologous plus allogeneic blood) (odds ratio 3.442; 95% CI, 1.349-10.40; p = 0.006). Of the 385 study patients, 309 underwent primary hip or knee replacement surgery. In this homogeneous subgroup, the postoperative infection rate was 4.6 percent after no transfusion or autologous transfusion and 11.9 percent after allogeneic transfusion (odds ratio 2.827; 95% CI 1.059-8.799; p = 0.036). Multivariate regression analysis confirmed buffy coat-depleted allogeneic blood transfusion as an independent variable associated with high risk for postoperative infection.


CONCLUSIONS
Buffy coat-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.
Innerhofer
P
P
Department of Anesthesia, Leopold-Franzens University of Innsbruck, Austria. Petra.Innerhofer@uibk.ac.at
Walleczek
C
C
Luz
G
G
Hobisch-Hagen
P
P
Benzer
A
A
Stöckl
B
B
Hessenberger
G
G
Nussbaumer
W
W
Schobersberger
W
W
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D003231:Conjunctivitis / Q000209:etiology / Q000382:microbiology; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010388:Pelvis / Q000601:surgery; D018410:Pneumonia, Bacterial / Q000209:etiology; D011024:Pneumonia, Viral / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D013131:Spine / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology*; D014552:Urinary Tract Infections / Q000209:etiology