title: Allogeneic red blood cell transfusion is an independent risk factor for the development of postoperative bacterial infection.
abstract: OBJECTIVE
  Allogeneic red blood cell transfusions may exert immunomodulatory effects in recipients including an increased rate of postoperative bacterial infection. It is controversial whether allogeneic transfusion is an independent predictor for the development of postoperative bacterial infection.
  
  
  METHODS
  We analysed a prospectively collected database of 1,349 patients undergoing colorectal surgery in 11 centres across Canada. The primary outcome was the development of either a postoperative wound infection or intra-abdominal sepsis in transfused and nontransfused patients. The effect of allogeneic transfusion on postoperative infection was evaluated with adjustment for all the confounding factors in a multiple regression analysis.
  
  
  RESULTS
  The 282 patients who received a total of 832 allogeneic units had a significantly higher frequency of wound infections and intra-abdominal sepsis than the patients who were not transfused (25. 9 vs. 14.2%, p = 0.001). A significant dose-response relationship between transfusion and infection rate was demonstrated. Multiple regression analysis identified allogeneic transfusion as a statistically significant independent predictor for postoperative bacterial infection (OR 1.18, 95% CI 1.05-1.33, p = 0.007). Other independent predictors were anastomotic leak, repeat operation, patient age and preoperative haemoglobin level. The mortality rate was also significantly higher in the transfused group.
  
  
  CONCLUSIONS
  These data support the hypothesis that allogeneic red cell transfusion is an independent risk factor for the development of postoperative bacterial infection in patients undergoing colorectal surgery. This association provides further reason to minimise exposure to allogeneic transfusions in the perioperative setting.
authors.affiliation: Department of Medicine and Surgery, The Toronto Hospital, Mt. Sinai Hospital and The University of Toronto, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Chang
authors.forename: G A
authors.initials: GA
authors.lastname: Hall
authors.forename: W H
authors.initials: WH
authors.lastname: Geerts
authors.forename: C
authors.initials: C
authors.lastname: Greenwood
authors.forename: R S
authors.initials: RS
authors.lastname: McLeod
authors.forename: G D
authors.initials: GD
authors.lastname: Sher
mesh_terms: D000005:Abdomen / Q000382:microbiology; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D003107:Colorectal Surgery / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D015996:Survival Rate; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology