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Packed red blood cells increased infection risk after cardiac surgery

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Patients with packed red blood cells had an increased risk for major infection after cardiac surgery, according to study results presented at The Society of Thoracic Surgeons 48th Annual Meeting.

Researchers enrolled 5,184 adult patients (mean age, 64.4 years) to assess major and minor infections based on CDC/National Healthcare Safety Network definitions experienced after cardiac surgery. An independent committee of infectious disease experts adjudicated all infections. Isolated CABG (31%; n=1,597) and isolated valve (30%; n=1,549) with a mean bypass time of 115.4 minutes were the most common procedures, and 1.4% were reoperations. Mean baseline hemoglobin was 13.2 mg/dL.

Risk for infection was associated with packed red blood cells and platelets, according to study results. Packed red blood cells were transfused in 48% (n=2,491; mean 4.1 units) of patients, and platelets were transfused in 31% (n=1,610; mean 5.9 units) of patients. Among those receiving platelet transfusions, pneumonia (3.7%) and bloodstream infections (2%) were the most common infections.

Using multivariable logistic regression and Cox modeling, researchers also found a dose-dependent association between quantities of packed red blood cells and risk for infection. Study results showed that the crude risk increased by 31% with each packed red blood cell unit (P<.001). However, the risk for infection decreased with platelet transfusion. After adjusting for overall risk for infection, researchers found risk for death was 3.2 times higher and risk for an additional day of hospital stay was 1.32 times higher.

“Efforts to reduce packed red blood cell transfusions may significantly reduce the incidence of major post-operative infections,” researchers concluded.

For more information:

• Horvath KA. Do blood transfusions affect the risk of infections after cardiac surgery? Experience of the NIH/CIHR Cardiothoracic Surgical Trials Network. Presented at: The Society of Thoracic Surgeons 48th Annual Meeting; Jan. 28-Feb. 1, 2012; Fort Lauderdale, Fla.

Disclosure: The researchers report no relevant financial disclosures.

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