The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection

Authors

  • Walter P. Weber,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Marcel Zwahlen,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Stefan Reck,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Heidi Misteli,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Rachel Rosenthal,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Andreas S. Buser,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Mark Kaufmann,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Daniel Oertli,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Andreas F. Widmer,

    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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  • Walter R. Marti

    Corresponding author
    1. From the Department of General Surgery, the Blood Transfusion Centre, the Department of Anesthesia, and the Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel; and the Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
      Walter Richard Marti, MD, FACS, Vice Chairman, Department of Surgery, Division of General Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland; e-mail: wrmarti@uhbs.ch.
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  • The first two authors contributed equally to this work.

Walter Richard Marti, MD, FACS, Vice Chairman, Department of Surgery, Division of General Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland; e-mail: wrmarti@uhbs.ch.

Abstract

BACKGROUND: The purpose of the study was to investigate allogeneic blood transfusion (ABT) and preoperative anemia as risk factors for surgical site infection (SSI).

STUDY DESIGN AND METHODS: A prospective, observational cohort of 5873 consecutive general surgical procedures at Basel University Hospital was analyzed to determine the relationship between perioperative ABT and preoperative anemia and the incidence of SSI. ABT was defined as transfusion of leukoreduced red blood cells during surgery and anemia as hemoglobin concentration of less than 120 g/L before surgery. Surgical wounds and resulting infections were assessed to Centers for Disease Control standards.

RESULTS: The overall SSI rate was 4.8% (284 of 5873). In univariable logistic regression analyses, perioperative ABT (crude odds ratio [OR], 2.93; 95% confidence interval [CI], 2.1 to 4.0; p < 0.001) and preoperative anemia (crude OR, 1.32; 95% CI, 1.0 to 1.7; p = 0.037) were significantly associated with an increased odds of SSI. After adjusting for 13 characteristics of the patient and the procedure in multivariable analyses, associations were substantially reduced for ABT (OR, 1.25; 95% CI, 0.8 to 1.9; p = 0.310; OR, 1.07; 95% CI, 0.6 to 2.0; p = 0.817 for 1-2 blood units and ≥3 blood units, respectively) and anemia (OR, 0.91; 95% CI, 0.7 to 1.2; p = 0.530). Duration of surgery was the main confounding variable.

CONCLUSION: Our findings point to important confounding factors and strengthen existing doubts on leukoreduced ABT during general surgery and preoperative anemia as risk factors for SSIs.

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