Blood Management and Infections in Cardiovascular and Orthopedic Surgery

Conference: ASA
Division: Cognigen


Objectives: Numerous risks are associated with allogeneic blood transfusions. Various blood management techniques have evolved which minimize or eliminate the use of allogeneic blood. This study compared infection rates associated with blood management techniques in patients undergoing cardiac and orthopedic surgeries where anticipated blood loss exceeds 1,000 mL.

Methods: Patients were enrolled at nine hospitals. Postoperative infection rate (to patient discharge) was compared between patients receiving allogeneic (includes allogeneic, +/- autologous, +/- reinfused blood and volume replacement) and other (non-allogeneic and/or volume replacement) transfusions. Relative risk and 95% confidence intervals were calculated to compare infection rates. Statistical significance was defined as p < 0.05.

Results: The overall infection rate was 5.8%; 2.2% for orthopedic patients and 13.9% for cardiac patients. The infection types included: pneumonia (n=21), sepsis (n=4), urinary tract infection (n=24), incisional wound infection (n=17), catheter associated infection (n=4), osteomyelitis (n=1), cardiovascular infection (n=2), other (n=20). Overall, the relative risk (95% CI) of postoperative infection was 3.6 (2.4, 5.4, p=0.001) times greater in the allogeneic group. When separated by surgery type, the relative risk of infection with allogeneic transfusion (95% CI) was 1.9 (0.8, 4.8, p=0.164) in orthopedic patients and 1.9 (1.1, 3.1, p=0.014) in cardiac patients.

Conclusions: Overall, an increased risk of postoperative infection associated with receipt of allogeneic blood was observed; a similar trend was observed when cardiac and orthopedic patients were separately considered.

American Society of Anesthesiologists (ASA), Las Vegas, Nevada, October 2004

By Aryeh Shander, M.D., Cynthia A. Walawander, M.A., and the Blood Management Demonstration Group