title: Impact of Transfusion Threshold on Infectious Complications After Ileal Pouch-Anal Anastomosis.
abstract: BACKGROUND
  This study was conducted to investigate the impact of different hemoglobin level-based transfusion practices on infectious complications after surgery for ulcerative colitis.
  
  
  METHODS
  Patients who underwent ileal pouch-anal anastomosis for ulcerative colitis between January 2008 and December 2013 were identified and divided into four groups: group 1 with hemoglobin ≥ 10 and group 2 with hemoglobin ≥ 7 and <10 g/dL who did not receive transfusion and group 3 with hemoglobin ≥ 7 and <10 and group 4 with hemoglobin < 7 g/dL who received transfusion. Clinical characteristics and septic complications within postoperative 30 days were compared.
  
  
  RESULTS
  There were 237, 341, 40, and 20 patients in groups 1, 2, 3, and 4, respectively. All the groups were comparable regarding perioperative characteristics except for age, gender, preoperative albumin and hemoglobin levels, and operative blood loss. The rates of overall septic complications were 18.6, 26.7, 47.5, and 40 % in the groups 1, 2, 3 and 4, respectively. In multivariate analysis, compared to group 2, group 3 was associated with an increased likelihood of developing organ/space (odds ratio (OR) = 4.34, p = 0.004) and overall surgical site infections (SSIs) (OR = 2.81, p = 0.01).
  
  
  CONCLUSIONS
  Blood transfusion decided based on a perioperative hemoglobin (Hgb) level above 7 mg/dL is associated with higher overall and organ/space SSIs.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. gorgune@ccf.org.|Department of Colorectal Surgery, Digestive Disease Institute, Desk A 30, 9500 Euclid Ave., Cleveland, OH, 44195, USA. gorgune@ccf.org.
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Volkan
authors.initials: V
authors.lastname: Ozben
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozuner
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Feza
authors.initials: F
authors.lastname: Remzi
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D006454:Hemoglobins
keywords: Postoperative infections; Surgery; Transfusion threshold; Ulcerative colitis