Blood Transfusion and Infection After Cardiac Surgery

• Type of Material: Article
• Authors: Keith A. Horvath, National Institutes of Health; Michael A. Acker, University of Pennsylvania School of Medicine; Helena Chang, Mount Sinai School of Medicine; Emilia Bagiella, Mount Sinai School of Medicine; Peter K. Smith, Duke University; Alexander Iribarne, Mount Sinai School of Medicine; Irving L. Kron, University of Virginia School of Medicine; Pamela Lackner, The Cleveland Clinic; Michael Argenziano, Columbia University; Deborah D. Ascheim, Mount Sinai School of Medicine; Annetine C. Gelijns, Mount Sinai School of Medicine; Robert E. Michler, Albert Einstein College of Medicine; Danielle Van Patten, Columbia University; John Puskas, Emory University; Karen O'Sullivan, Mount Sinai School of Medicine; Dorothy Kliniewski, University of Pennsylvania School of Medicine; Neal O. Jeffries, National Heart, Lung, and Blood Institute; Patrick T. O'Gara, Brigham and Women's Hospital; Alan J. Moskowitz, Mount Sinai School of Medicine; Eugene Blackstone, The Cleveland Clinic
• Language: English
• Date: 2013-06-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 The Society of Thoracic Surgeons.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.athoracsur.2012.11.078
• Title of Journal or Parent Work: Annals of Thoracic Surgery
• Volume: 95
• Issue: 6
• Start Page: 2194
• End Page: 2201
• Keywords: HEART-SURGERY; Cardiac & Cardiovascular Systems; Respiratory System; Cardiovascular System & Cardiology; MORBIDITY; CARDIOPULMONARY BYPASS; LONG-TERM SURVIVAL; MORTALITY; Science & Technology; ARTERY-BYPASS-SURGERY; POSTOPERATIVE BACTERIAL-INFECTION; Surgery; IMPACT; Life Sciences & Biomedicine; CELL TRANSFUSION; CONSERVATION
• Research Categories: Health Sciences, Medicine and 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.