title: Blood transfusion for lower extremity bypass is associated with increased wound infection and graft thrombosis.
abstract: BACKGROUND
  Packed RBC transfusion has been postulated to increase morbidity and mortality after cardiac/general surgical operations, but its effects after lower extremity bypass (LEB) have not been studied extensively.
  
  
  METHODS
  Using the Vascular Study Group of New England's database (2003-2010), we examined 1,880 consecutive infrainguinal LEB performed for critical limb ischemia. Perioperative transfusion was categorized as 0 U, 1 to 2 U, and ≥3 U. Cohort frequency group matching was used to compare groups of patients receiving 1 to 2 U and 0 U with patients receiving ≥3 U using age, coronary artery disease, diabetes, urgency, and indication of revascularization. Primary end points were perioperative mortality, wound infection, and loss of primary graft patency at discharge, as well as 1-year mortality and loss of primary graft patency.
  
  
  RESULTS
  In the study cohort, 1,532 LEBs (81.5%) received 0 U, 248 LEBs (13.2%) received 1 to 2 U, and 100 LEBs (5.3%) received ≥3 U transfusion. In the study cohort and group frequency matched cohort, transfusion was associated with significantly higher perioperative wound infection (0 U:4.8% vs 1 to 2 U: 6.5% vs ≥3 U: 14.0%; p = 0.0004) and graft thrombosis at discharge (4.5% vs 7.7% vs 15.3%; p < 0.0001). At 1 year, there were no differences in infection or graft patency. In multivariate analysis, transfusion was independently associated with increased perioperative wound infection in the study cohort and group frequency matched cohort (1 to 2 U vs 0 U: adjusted odds ratio [OR] = 1.4; 95% CI, 0.8-2.5; p = 0.263; ≥3 U vs 0 U: OR = 3.5; 95% CI, 1.8-6.7; p = 0.0002; overall p = 0.002) and increased graft thrombosis at discharge (1 to 2 U vs 0 U: OR = 2.1; 95% CI, 1.2-3.6; p = 0.01; ≥3 U vs 0 U: OR = 4.8; 95% CI, 2.5-9.2; p < 0.0001, overall p < 0.0001).
  
  
  CONCLUSIONS
  Perioperative transfusion in patients undergoing LEB is associated with increased perioperative wound infection and graft thrombosis. From this observational study, it appears transfusion does not have major consequences during mid-term follow-up, but the presumed benefits of blood replacement should be weighed carefully because of the increased risk of perioperative complications with transfusion.
authors.affiliation: Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 73110, USA. ttan1@lsuhsc.edu
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.forename: Robert T
authors.initials: RT
authors.lastname: Eberhardt
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.forename: Jens
authors.initials: J
authors.lastname: Eldrup-Jorgensen
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006085:Graft Survival; D006801:Humans; D015993:Life Tables; D023821:Limb Salvage; D008145:Louisiana / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
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