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Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn's
Nan Lan1, Luca Stocchi2, Yi Li2
1Center for Inflammatory Bowel Disease, and Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Insights
Intraoperative and postoperative blood transfusions (BT) increase infectious complications in Crohn's disease (CD) surgery patients. Preoperative BT, however, does not pose the same risk, emphasizing careful consideration of transfusion timing.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Disease Epidemiology
Background:
- Previous research indicated blood transfusion (BT) is linked to post-operative complications in Crohn's disease (CD) surgery.
- This study aimed to validate the association between perioperative BT and infectious complications in CD patients using a large national database.
Purpose of the Study:
- To investigate the relationship between perioperative blood transfusion and the incidence of infectious complications following surgery for Crohn's disease.
- To identify whether the timing of blood transfusion influences the risk of post-operative infections in CD patients.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2013).
- Included patients undergoing surgery for Crohn's disease, analyzing infectious complications as the primary outcome.
- Performed multivariate analyses to determine independent risk factors for post-operative infections.
Main Results:
- Out of 10,100 CD patients, 6.0% received perioperative BT and had significantly higher rates of infectious complications.
- Intraoperative and/or postoperative BT was an independent risk factor for infectious complications (OR=2.2, p<0.001), with risk increasing per unit of RBC transfused.
- Preoperative BT was not associated with an increased risk of post-operative infections.
Conclusions:
- Intraoperative and postoperative blood transfusions are associated with a higher risk of infectious complications in Crohn's disease surgical patients.
- Preoperative blood transfusions did not show an association with increased infectious complications.
- The timing of blood transfusions in CD surgery requires careful risk-benefit assessment.
Background:
We have previously demonstrated that blood transfusion (BT) was associated with post-operative complications in patients undergoing surgery for Crohn's disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.
Methods:
All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP. Variables were defined according to the ACS NSQIP guidelines. The primary outcome was infectious complications, including superficial, deep and organ/space surgical site infection, wound dehiscence, urinary tract infection, pneumonia, systemic sepsis and septic shock. Multivariate analyses were performed to assess the risk factors for post-operative infections.
Results:
All 10 100 eligible patients were included and 611 (6.0%) received perioperative BT. BT patients were older, lighter in weight and more likely to be functionally dependent. BT patients were more likely to have post-operative infectious complications than those without BT, including superficial surgical site infection (SSI) (10.8% vs 7.4%, p=0.002), deep SSI (3.3% vs 1.6%, p=0.003), organ/space SSI (14.2% vs 5.4%, p<0.001), pneumonia (3.8% vs 1.3%, p<0.001), urinary tract infection (3.9% vs 2.2%, p=0.006), sepsis (11.5% vs 4.5%, p<0.001) and sepsis shock (3.1% vs 0.8%, p<0.001). Multivariate analysis showed that intra- and/or post-operative BT was an independent risk factor for post-operative infectious complications (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.8-2.7; p<0.001) and the risk increased with each administered unit of red blood cell (OR = 1.3, 95% CI: 1.2-1.5). Other independent factors were history of smoking, chronic heart disease, diabetes, hypertension and the use of corticosteroids. Pre-operative BT, however, was not found to be a risk factor to post-operative infections.
Conclusions:
Intra- and/or post-operative, not pre-operative, BT was found to be associated with an increased risk for post-operative infectious complications in this CD cohort. Therefore, the timing and risks and benefits of BT should be carefully balanced.