Postoperative Infection Rate Following Cardiac Surgery With Allogeneic vs Other Blood Management Techniques

Authors: Shander A, Walawander CA, Shore-Lesserson L, Adams D
Conference: Society for the Advancement of Blood Medicine (SABM)
Keywords: adult, allogeneic, chi square, Fisher's exact test, infectious disease, logistic regression, nosocomial, observational, surgery, t-test, transfusion, Wilcox rank-sum
Division: Clinical Pharmacology and Pharmacometrics (CPP)

Abstract

Objectives: Infection rates associated with allogeneic blood transfusion versus other blood management techniques were prospectively compared in elective cardiac surgery patients (anticipated blood loss > 1000 mL).

Methods: Patients from seven participating hospitals were grouped into those receiving any allogeneic transfusions and those receiving no allogeneic transfusion (but may have received autologous blood, volume replacement or reinfused blood). The relative risk +/- 95% CI’s for postoperative inpatient infection and 30-day post discharge infection obtained through a nurse telephone interview were compared (p < 0.05). Post discharge quality of life outcomes were also examined.

Results: Overall, 253 of 455 patients (56%) received allogeneic transfusions. Infections occurred in 44 (17.4%) of these patients during hospitalization compared to 19 (9.4%) patients in the other transfusion group, (RR=1.9; 95% CI (1.1, 3.1), p=0.014). This association remained after adjustment for age, gender, ASA class, race, and pre-existing medical conditions such as respiratory, gastrointestinal, and hematologic disease. A post discharge interview was conducted with 330 patients (53% allogeneic vs 47% other). In the allogeneic blood group, 14.2% had an infection after discharge compared to 16.2% in the other transfusion group, p=0.608. Patients receiving allogeneic transfusion were less likely to resume activities 30 days post discharge (59% vs 76%, p=0.001), were more likely to be fatigued (66% vs 55%, p=0.038), and exhibited a trend towards a lower likelihood of complete independence (50% vs 61%, p=0.083).

Conclusions: Allogeneic blood transfusion was associated with an increased risk of infection during hospitalization for cardiac surgery, but was not observed in patients surveyed 30 days after discharge. A negative impact on post discharge quality of life outcomes was evident in patients who had received allogeneic products, however.

Society for the Advancement of Blood Medicine (SABM), Miami, Florida, September 2004

By A. Shander, M.D., Cynthia A. Walawander, M.A., L. Shore-Lesserson, M.D. and D. Adams, M.D.