Blood transfusion and infection after cardiac surgery

Keith A. Horvath, Michael A. Acker, Helena Chang, Emilia Bagiella, Peter K. Smith, Alexander Iribarne, Irving L. Kron, Pamela Lackner, Michael Argenziano, Deborah D. Ascheim, Annetine C. Gelijns, Robert E. Michler, Danielle Van Patten, John D. Puskas, Karen O'Sullivan, Dorothy Kliniewski, Neal O. Jeffries, Patrick T. O'Gara, Alan J. Moskowitz, Eugene H. Blackstone

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. The most common procedures were isolated coronary artery bypass graft surgery (31%) and isolated valve surgery (30%); 19% were reoperations. Infections were adjudicated by independent infectious disease experts. Multivariable Cox modeling was used to assess the independent effect of blood and platelet transfusions on major infections within 60 ± 5 days of surgery. Red blood cells (RBC) and platelets were transfused in 48% and 31% of patients, respectively. Each RBC unit transfused was associated with a 29% increase in crude risk of major infection (p < 0.001). Among RBC recipients, the most common infections were pneumonia (3.6%) and bloodstream infections (2%). Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.

Original languageEnglish (US)
Pages (from-to)2194-2201
Number of pages8
JournalAnnals of Thoracic Surgery
Volume95
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Blood Transfusion
Thoracic Surgery
Infection
Erythrocytes
Platelet Transfusion
Transplants
Heart-Assist Devices
Practice Management
Ultrafiltration
Vacuum
Ambulatory Surgical Procedures
Reoperation
Hematocrit
Coronary Artery Bypass
Chronic Obstructive Pulmonary Disease
Communicable Diseases
Creatinine
Pneumonia
Blood Platelets
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Horvath, K. A., Acker, M. A., Chang, H., Bagiella, E., Smith, P. K., Iribarne, A., ... Blackstone, E. H. (2013). Blood transfusion and infection after cardiac surgery. Annals of Thoracic Surgery, 95(6), 2194-2201. https://doi.org/10.1016/j.athoracsur.2012.11.078

Blood transfusion and infection after cardiac surgery. / Horvath, Keith A.; Acker, Michael A.; Chang, Helena; Bagiella, Emilia; Smith, Peter K.; Iribarne, Alexander; Kron, Irving L.; Lackner, Pamela; Argenziano, Michael; Ascheim, Deborah D.; Gelijns, Annetine C.; Michler, Robert E.; Van Patten, Danielle; Puskas, John D.; O'Sullivan, Karen; Kliniewski, Dorothy; Jeffries, Neal O.; O'Gara, Patrick T.; Moskowitz, Alan J.; Blackstone, Eugene H.

In: Annals of Thoracic Surgery, Vol. 95, No. 6, 06.2013, p. 2194-2201.

Research output: Contribution to journalArticle

Horvath, KA, Acker, MA, Chang, H, Bagiella, E, Smith, PK, Iribarne, A, Kron, IL, Lackner, P, Argenziano, M, Ascheim, DD, Gelijns, AC, Michler, RE, Van Patten, D, Puskas, JD, O'Sullivan, K, Kliniewski, D, Jeffries, NO, O'Gara, PT, Moskowitz, AJ & Blackstone, EH 2013, 'Blood transfusion and infection after cardiac surgery', Annals of Thoracic Surgery, vol. 95, no. 6, pp. 2194-2201. https://doi.org/10.1016/j.athoracsur.2012.11.078
Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A et al. Blood transfusion and infection after cardiac surgery. Annals of Thoracic Surgery. 2013 Jun;95(6):2194-2201. https://doi.org/10.1016/j.athoracsur.2012.11.078
Horvath, Keith A. ; Acker, Michael A. ; Chang, Helena ; Bagiella, Emilia ; Smith, Peter K. ; Iribarne, Alexander ; Kron, Irving L. ; Lackner, Pamela ; Argenziano, Michael ; Ascheim, Deborah D. ; Gelijns, Annetine C. ; Michler, Robert E. ; Van Patten, Danielle ; Puskas, John D. ; O'Sullivan, Karen ; Kliniewski, Dorothy ; Jeffries, Neal O. ; O'Gara, Patrick T. ; Moskowitz, Alan J. ; Blackstone, Eugene H. / Blood transfusion and infection after cardiac surgery. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 6. pp. 2194-2201.
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