title: Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty.
abstract: BACKGROUND
  Up to 70% of patients who undergo total hip or total knee arthroplasty receive blood transfusions. Using data from more than 12,000 patients assessed in the Phase-III RECORD (Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism) studies, we investigated whether allogeneic blood transfusion increases the risk of postoperative infection compared with autologous blood transfusion or no transfusion.
  
  
  METHODS
  A post hoc analysis of the pooled RECORD data stratified patients into three groups according to the type of blood transfusion that they received: no transfusion (n = 6313), autologous blood transfusion (n = 1902), and allogeneic blood transfusion with or without autologous blood transfusion (n = 3962). The types of postoperative infection were recorded and included lower or upper respiratory tract and lung infection, bone and joint infection, wound inflammation or infection, urinary tract infection, and other infections.
  
  
  RESULTS
  The rates of infection in patients receiving no transfusion or autologous blood transfusion were similar; therefore, data from these two groups were combined. The rate of any infection was 9.9% (392 of 3962) in patients receiving allogeneic blood transfusion and 7.9% (646 of 8215) in patients not receiving allogeneic blood transfusion with or without autologous blood transfusion (p = 0.003). The rates of lower or upper respiratory tract and lung infection (2.1% [eighty-five of 3962] versus 1.3% [109 of 8215]; p = 0.002) and of wound inflammation or infection (2.4% [ninety-four of 3962] versus 1.7% [138 of 8215]; p = 0.046) were significantly higher in patients receiving allogeneic blood transfusion compared with patients not receiving allogeneic blood transfusion. When comparing patients who had received allogeneic blood transfusion with those who had not received allogeneic blood transfusion, the rates of bone and joint infection (0.4% [fourteen of 3962] versus 0.2% [eighteen of 8215]; p = 0.056), of urinary tract infection (3.1% [123 of 3962] versus 2.5% [209 of 8215]; p = 0.551), and of other infections (3.0% [120 of 3962] versus 2.7% [225 of 8215]; p = 0.308) were not significantly different.
  
  
  CONCLUSIONS
  The rates of any infection, lower or upper respiratory tract and lung infection, and wound inflammation or infection were significantly increased after elective total hip or total knee arthroplasty in patients receiving allogeneic blood transfusion compared with those receiving autologous blood transfusion or no blood transfusion.
authors.affiliation: Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston Orthopaedic Associates, 1012 Physicians Drive, Charleston, SC 29414. E-mail address: rjfriedman@mybones.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Friedman
authors.affiliation: Bayer Pharma AG, Aprather Weg 18a, 42096 Wuppertal, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Homering
authors.affiliation: Bayer Pharma AG, Müllerstrasse 178, 13342 Berlin, Germany.
authors.forename: Gerlind
authors.initials: G
authors.lastname: Holberg
authors.affiliation: Bayer HealthCare Pharmaceuticals, PO Box 1000, Montville, NJ 07045.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Berkowitz
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome