Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Infection Control

Background:

• Cell salvage is a technique used to recover and reinfuse a patient's own blood lost during surgery.
• The safety and efficacy of cell salvage, particularly concerning postoperative infection rates, remain areas of investigation in cardiac surgery.

Purpose of the Study:

• To evaluate the primary outcome of infection risk following intraoperative cell salvage in patients undergoing cardiac surgery.
• To analyze the direct and indirect effects of cell salvage on postoperative infections, considering allogeneic transfusion as a mediator.

Main Methods:

• A randomized controlled trial involving 716 patients across six Dutch cardiac surgery centers.
• Data collected over four years on patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures.
• Postoperative infection assessment utilized Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions.

Main Results:

• Patients undergoing cell salvage experienced higher infection rates (15.9%) compared to controls (13.1%).
• Cell salvage showed a direct association with increased infection risk (OR 2.291, p=0.015).
• Allogeneic transfusion also directly increased infection risk (OR 2.082, p=0.018), while processed cell salvage blood did not significantly impact infections (OR 0.999, p=0.089).

Conclusions:

• Cell salvage is directly associated with higher postoperative infection rates in cardiac surgery.
• The indirect protective effect of cell salvage, primarily through the reduction of allogeneic blood transfusions, significantly mitigates the direct risk of infection.
• This suggests that cell salvage can be safely employed in cardiac surgery when considering its overall impact on transfusion needs and subsequent infection risk.