The Association Between Perioperative Allogeneic Transfusion Volume and Postoperative Infection in Patients Following Lumbar Spine Surgery

Woods, Barrett I.; Rosario, Bedda L.; Chen, Antonia F.; Waters, Jonathan H.; Donaldson, William; Kang, James D.; Lee, Joon

doi:10.2106/jbjs.l.00979

Cited by 61 publications

(60 citation statements)

References 55 publications

(52 reference statements)

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“…This is in line with a recent large retrospective matched case-control study that reported an association between SSI after lumbar spine surgery and the volume of peri-operative allogeneic red blood cell transfusion [14]. Other studies on this issue investigated outcomes after general surgery.…”

Section: Discussionsupporting

confidence: 87%

“…The first is that patients who required blood transfusions had previous loss of blood and therefore had lower oxygen and nutrition transporters to support appropriate healing. As in other studies on this issue [12,14], the difference between patients with and without incisional infection with regard to pre-operative hemoglobin concentration and hematocrit was marginal. Thus, the hypothesis of an undersupply of oxygen and nutrients as a result of blood loss is unlikely, at least in institutions with appropriate peri-operative transfusion management.…”

Section: Discussionsupporting

confidence: 72%

“…It is a limitation of this study that because of the retrospective design, we were not able to evaluate the severity and modalities of the injuries. However, a three-to four-fold higher risk of SSI after preoperative allogeneic blood transfusions has been reported for non-trauma patients as well [14,15]. Metastatic disease fractures as the cause of spinal instability were not linked to higher SSI rates, either in our study or in the literature [27,28].…”

Section: Discussioncontrasting

confidence: 42%

“…A purported association between pre-operative blood transfusion and a higher rate of SSIs has been controversial [11][12][13][14][15]. Some authors presume immuno-suppressive effects as a reaction to allogenic transfusions to be responsible for a higher rate of malignant disease recurrence and nosocomial infections [15][16][17].…”

mentioning

confidence: 99%

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Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Osterhoff

Burla

Werner

et al. 2015

Surgical Infections

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BACKGROUND Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. METHODS In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patientspecific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans. RESULTS Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p=0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p=0.519) or hematocrit (p=0.908). The SFT did not differ in the two groups. CONCLUSIONS Allogeneic red blood cell transfusion within 48 h prior to surgery was an independent risk factor for SSI after posterior fusion for the fixation of thoracic spine instabilities. Pre-operative blood transfusion tripled the risk, whereas SFT had no influence on the occurrence of SSI. Background: Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. Methods: In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patient-specific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans.Results: Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p = 0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p = 0.519) or hematocrit (p = 0.908). The SFT did not differ in the two groups. Conclusions: Allogeneic red blood cell transfusion within 48 h p...

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 72%

Section: Discussioncontrasting

confidence: 42%

mentioning

confidence: 99%

See 2 more Smart Citations

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Osterhoff

Burla

Werner

et al. 2015

Surgical Infections

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“…As the rate of spinal fusion surgery increases in the USA, particularly among older patients [21], understanding the relationship between transfusion and clinical outcomes is relevant to optimizing clinical care while reducing costs [10]. Although the association between transfusion and infection after spine procedures has been described previously [16, 25, 32], to our knowledge, this study is the first to investigate noninfectious outcomes and the relationship between transfusion and these complications.…”

Section: Discussionmentioning

confidence: 98%

Thrombotic and Infectious Morbidity Are Associated with Transfusion in Posterior Spine Fusion

Johnson

Cohen

et al. 2017

HSS Jrnl

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BackgroundAlthough previous investigators have established an association between blood transfusion and adverse outcomes, the relative frequency of different morbid events and the association with transfusion dose are not well understood.Questions/PurposesThe purpose of the study is to characterize the relationship between blood transfusion and different types of morbidity after posterior spine fusion.MethodsWe retrospectively analyzed electronic medical records for 963 patients who underwent posterior spinal fusion surgery at a single institution, of which 603 (62.6%) received an allogeneic blood transfusion. Then, we assessed patient and surgical characteristics in a risk-adjusted fashion to identify various morbid event rates and independent predictors in these adverse outcomes.ResultsCompared to the non-transfused patients, transfused patients had a higher incidence of any morbid event (9.1 vs. 2.5%. P < 0.0001), thrombotic events (4.6 vs. 1.1%, P = 0.0025), and hospital-acquired infections (2.3 vs. 0.6%, P = 0.039). Renal, respiratory, and ischemic morbidity occurred less frequently and were not more common in transfused patients. Risk-adjusted analysis revealed a dose-response effect, whereby for each unit of allogeneic blood transfused, the risks of any morbid event (OR 1.183; 95% CI 1.103–1.274; P < 0.0001), thrombotic complication (OR 1.104; 95% CI 1.032–1.194; P = 0.0035), and infectious complication (OR 1.182; 95% CI 1.077–1.332; P = 0.0002) were increased.ConclusionOur data demonstrate risk-adjusted and transfusion dose-related increases in perioperative morbidity, with thrombotic and infectious events being the most common.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-017-9545-9) contains supplementary material, which is available to authorized users.

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Postoperative Care of the Cerebral Palsy Patient

Alharash¹,

Ames²,

Mathew³

et al. 2018

Cerebral Palsy

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The Association Between Perioperative Allogeneic Transfusion Volume and Postoperative Infection in Patients Following Lumbar Spine Surgery

Abstract: Background: Perioperative allogeneic red blood cell transfusion is a risk factor for surgical site infection. The purpose of

Cited by 61 publications

References 55 publications

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Thrombotic and Infectious Morbidity Are Associated with Transfusion in Posterior Spine Fusion

Postoperative Care of the Cerebral Palsy Patient

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