title: Blood transfusion and infection after cardiac surgery.
abstract: Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. The most common procedures were isolated coronary artery bypass graft surgery (31%) and isolated valve surgery (30%); 19% were reoperations. Infections were adjudicated by independent infectious disease experts. Multivariable Cox modeling was used to assess the independent effect of blood and platelet transfusions on major infections within 60 ± 5 days of surgery. Red blood cells (RBC) and platelets were transfused in 48% and 31% of patients, respectively. Each RBC unit transfused was associated with a 29% increase in crude risk of major infection (p < 0.001). Among RBC recipients, the most common infections were pneumonia (3.6%) and bloodstream infections (2%). Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.
authors: Cardiothoracic Surgery Research Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors: Keith A
authors: KA
authors: Horvath
authors: Michael A
authors: MA
authors: Acker
authors: Helena
authors: H
authors: Chang
authors: Emilia
authors: E
authors: Bagiella
authors: Peter K
authors: PK
authors: Smith
authors: Alexander
authors: A
authors: Iribarne
authors: Irving L
authors: IL
authors: Kron
authors: Pamela
authors: P
authors: Lackner
authors: Michael
authors: M
authors: Argenziano
authors: Deborah D
authors: DD
authors: Ascheim
authors: Annetine C
authors: AC
authors: Gelijns
authors: Robert E
authors: RE
authors: Michler
authors: Danielle
authors: D
authors: Van Patten
authors: John D
authors: JD
authors: Puskas
authors: Karen
authors: K
authors: O'Sullivan
authors: Dorothy
authors: D
authors: Kliniewski
authors: Neal O
authors: NO
authors: Jeffries
authors: Patrick T
authors: PT
authors: O'Gara
authors: Alan J
authors: AJ
authors: Moskowitz
authors: Eugene H
authors: EH
authors: Blackstone
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D001803:Blood Transfusion / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D065227:Transfusion Reaction; D016896:Treatment Outcome
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