DOI: 10.1097/00000539-199904001-00058

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Issn Print: 0003-2999

Publication Date: 1999/04/01


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INFECTIOUS COMPLICATIONS FOLLOWING CARDIAC SURGERY: DO LEUCOCYTE DEPLETED BLOOD TRANSFUSIONS MAKE A DIFFERENCE?

AD Sharma; M Stafford Smith; MF Newman; SJ Bredehoeft; NP deBruijn; B Phillips-Bute; PK Smith; FM Clements

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INTRODUCTION: Coronary bypass graft surgery (CABG) consumes more health care resources than any other single treatment [1]. Postoperative infectious complications occur in 0.5% to 5% of patients following cardiac surgery, and result in major increases in morbidity, mortality and cost [1]. Leucocyte depleted (LD) blood transfusion is associated with reduced infections in patients undergoing colorectal surgery [2]. We therefore postulated that Leucocyte depleted (LD) blood transfusion reduces postoperative infections following coronary bypass graft surgery (CABG).
METHODS: Demographic, transfusion and infection data were gathered from Anesthesia, Surgery and Transfusion Databases, for patients undergoing primary elective coronary bypass graft surgery (CABG) between July'95 and Jan'98 and receiving red blood cell transfusions for up to 48 hrs postoperatively. Patients were grouped according to the type of blood transfusion they received. [(Group A: LD blood only); (Group B: Non LD blood only); (Group C: Both LD and non LD)] A logistic regression model was used to identify predictors of infection (pneumonia, mediastinitis, leg and sternal wound, decubitus ulcers and urinary tract). Demographic variables [(bypass time, age, sex, weight; race, preoperative creatinine, hematocrit and number & type of blood transfusion received (LD or non LD)] were evaluated and compared using standard t test, p<.05 was considered significant.
RESULTS: A total of 2037 patients were analyzed. Group A (n = 100), Group B (n = 1794), Group C (n = 143). The overall infection rate following CABG surgery was 5.2%. The incidence was lowest in non transfused patients (3%). There was no difference in the infection rate in patients receiving LD or non LD blood (5.6% vs 5.5%). The number of units transfused and weight of the patients were significant predictors of infection. Table 1
DISCUSSION: Our study suggests no benefit of Leucocyte depleted (LD) blood transfusion in reducing postoperative infections in patients undergoing primary CABG surgery. Red blood cell transfusion increases postoperative infections. The association of increased postoperative infections following cardiac surgery with weight may suggest that the dosing of antibiotics should be made with the patient weight in mind rather than following a standardized dosing regime.

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