Blood transfusion and postoperative infection in orthopedic patients

Abstract

Adverse effects of the transfusion of homologous blood on tumor recurrence and resistance to bacterial infection have been reported previously, but the findings are inconclusive. A retrospective review of patients undergoing orthopedic surgery was conducted, and the rate of the postoperative infectious complications was compared among those receiving homologous blood, autologous blood, both types, or no transfusion support. An overall postoperative infection rate of 6.1 percent was observed: 6.9 percent among persons receiving homologous blood, 5.0 percent among those receiving autologous blood, 11.9 percent among those receiving both homologous and autologous blood, and 4.9 percent among those not receiving transfusions (p = 0.37). Among patients receiving homologous blood, a subset of 15 patients received homologous whole blood and had an infection rate of 20 percent. Significant predictors of postoperative infection included increasing age, spinal surgery, high admission hematocrit, and greater time in surgery. Of factors relating to transfusion, only the use of homologous whole blood was a significant predictor of postoperative infection, which suggests a detrimental effect of homologous plasma. It can be concluded that, in this group of patients undergoing relatively nontraumatic surgery, several variables that are not related to transfusion, as well as the use of homologous whole blood, were significant predictors of postoperative infection.

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

“…Similar observations were made in other studies [4,16]. The exact mechanism that results in higher rates of febrile episodes and wound problems after homologous transfusion has yet to be determined, but it seems that these problems can be reduced by avoiding the use of bank blood [6,7,10,24]. It is therefore clearly preferable not to transfuse blood if possible, especially in orthopaedic surgery in which deep infection is a devastating complication.…”

The incidence of complications in elective cranial neurosurgery associated with dural closure material

“…26,33 While the transfusion threshold used for patients is variable, severe, acute, blood loss anemia associated with craniotomy is treated with blood product transfusion, another known risk factor for postoperative infection. 8,11 We did not assess transfusion requirement as an independent variable because transfusion protocols are individualized to a variety of patient factors. We acknowledge that estimation of blood loss for any given surgical procedure is both poorly reproducible and typically underestimated.…”

Predeposit autologous donation in spinal surgery: a multicentre study

“…1 Pooled data from the nine medical centres included in this study, regarding the evolution of the use of PABD by patients undergoing spine surgery over the last ten years (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003) which are not included in the "safety tripod". In fact, there is increasing evidence that TRIM effects of ABT may be responsible for at least a 10% higher rate of postoperative infection in transfused patients, with longer hospital stays [6,25,27,28]. Several studies and clinical observations suggest that AUT might be clinically and immunologically less detrimental than ABT [26].…”

“…However, ABTs are not a risk-free therapy as they carry the potential risk of viral disease transmission, bacterial contamination, incompatibility reactions or transfusion-related immunomodulation (TRIM) [4]. The TRIM effect has been particularly implicated in the increased postoperative infection rate observed in patients who received ABT [6,25,26,27,28].…”

“…However, ABTs are not a risk-free therapy as they carry the potential risk of viral disease transmission, bacterial contamination, incompatibility reactions or transfusion-related immunomodulation (TRIM) [4]. The TRIM effect has been particularly implicated in the increased postoperative infection rate observed in patients who received ABT [6,25,26,27,28].Autologous blood transfusion (AUT) techniques have emerged as the principal means to avoid or reduce the need for ABT. These techniques involve the collection and reinfusion of the patient's own blood by using preoperative autologous blood donation (PABD), preoperative acute normovolaemic haemodilution, intraoperative salAbstract Background.…”