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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1092-1099, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PJ Murphy, C Connery, GL Hicks Jr and N Blumberg
Homologous transfusions are immunosuppressive and associated with a higher
risk of postoperative infection. In this retrospective analysis, we studied
238 consecutive patients who underwent first-time coronary operations by a
single surgeon in 1988 to 1989 and collected clinical and laboratory data
relevant to postoperative infections including pulmonary, urinary, and
wound sites. Culture-proved postoperative infections occurred in 16 of the
238 patients (6.7%), with only 3 (1.3%) being deep sternal wound
infections. Seven of 16 (44%) of the infections were away from the wound
sites, suggesting that nonsurgical variables contributed to at least some
infections. Factors significantly associated with an increased risk of
postoperative infection by univariate analysis included female sex,
diabetes mellitus, and transfusion dose. Infections occurred in 3.9% of
patients receiving up to 2 units of red cells and whole blood, 6.9%
receiving 3 to 5 units, and 22% of those receiving 6 units or more.
Multiple linear and logistic regression analysis showed that transfusion
dose was the most significant predictor of infection, days of fever, days
of antibiotic therapy, and length of hospital stay. Homologous transfusion
is associated (in a dose-dependent fashion) with a threefold to eightfold
increased risk of postoperative infection in patients undergoing coronary
artery operations. This increased risk of infection may be due to
transfusion-induced immunosuppression of the patient.
ARTICLES
Homologous blood transfusion as a risk factor for postoperative infection after coronary artery bypass graft operations
Transfusion Medicine Unit, University of Rochester Medical Center, N.Y. 14642.
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