title: Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery.
abstract: OBJECTIVE
  Infants and children undergoing open heart surgery routinely require multiple RBC transfusions. Children receiving greater numbers of RBC transfusions have increased postoperative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown.
  
  
  METHODS
  One hundred and twenty-eight consecutively transfused children undergoing repair or palliation of congenital heart disease with cardiopulmonary bypass who were participating in a randomized trial of washed versus standard RBC transfusions were evaluated for an association of RBC storage age and clinical outcomes. To avoid confounding with dose of transfusions and timing of infection versus timing of transfusion, a subgroup analysis of patients only transfused 1-2 units on the day of surgery was performed.
  
  
  RESULTS
  Mortality was low (4.9%) with no association between RBC storage duration and survival. The postoperative infection rate was significantly higher in children receiving the oldest blood (25-38 d) compared with those receiving the freshest RBCs (7-15 d) (34% vs 7%; p = 0.004). Subgroup analysis of subjects receiving only 1-2 RBC transfusions on the day of surgery (n = 74) also demonstrates a greater prevalence of infections in subjects receiving the oldest RBC units (0/33 [0%] with 7- to 15-day storage; 1/21 [5%] with 16- to 24-day storage; and 4/20 [20%] with 25- to 38-day storage; p = 0.01). In multivariate analysis, RBC storage age and corticosteroid administration were the only predictors of postoperative infection. Washing the oldest RBCs (> 27 d) was associated with a higher infection rate and increased morbidity compared with unwashed RBCs.
  
  
  CONCLUSIONS
  Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single-donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on postoperative infection rate in pediatric cardiac surgery are warranted.
authors.affiliation: 1Department of Pediatrics, University of Rochester, Rochester, NY. 2Department of Medicine, University of Rochester, Rochester, NY. 3Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY. 4Congenital Cardiac Surgery, University of Rochester, Rochester, NY. 5Department of Environmental Medicine, University of Rochester, Rochester, NY. 6Department of Anesthesiology, University of Rochester, Rochester, NY.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Pietropaoli
authors.forename: Kelly F
authors.initials: KF
authors.lastname: Henrichs
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
authors.forename: Karen S
authors.initials: KS
authors.lastname: Powers
authors.forename: Richard
authors.initials: R
authors.lastname: Phipps
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Spinelli
authors.forename: Michael
authors.initials: M
authors.lastname: Swartz
authors.forename: Francisco
authors.initials: F
authors.lastname: Gensini
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Daugherty
authors.forename: Emily
authors.initials: E
authors.lastname: Nazarian
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Rubenstein
authors.forename: Dawn
authors.initials: D
authors.lastname: Sweeney
authors.forename: Michael
authors.initials: M
authors.lastname: Eaton
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
mesh_terms: D000293:Adolescent; D001793:Blood Preservation / Q000009:adverse effects* / Q000379:methods; D058731:Blood Safety / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome