Abstract
Background and purpose
Assessment of risk factors associated with the use of perioperative allogeneic blood transfusion and the effect of transfusion on infectious complications after ileal pouch-anal anastomosis (IPAA).
Methods
All patients included had IPAA with ileostomy. They were divided into two groups: transfused (TRAN); nontransfused (NON). Data included age, gender, preoperative anemia (Hgb <9 l g/dl), operative blood loss, transfusion volume, incidence of postoperative infectious or anastomotic complications, and length of stay (LOS).
Results
The 1,202 patients eligible for the study were divided into: TRAN = 240 patients and NON = 962 patients. The patient age, sex, and preoperative steroid use were similar in both groups. Significantly, more patients in the TRAN group were anemic preoperatively (32 vs 11%; p<0.05) and the preoperative Hgb level was significantly lower in the TRAN (12.07; p<0.05 vs 13.34 g/dl). Transfusion was required more frequently in anemic patients (p<0.001). The overall infection rate was significantly higher in the TRAN (48.75 vs 11.22%, p<0.001), Anastomotic separation (10.83 vs 3.32%, TRAN and NON, respectively; p<0.001) and fistula formation percentage (20.8 vs 4.46%, TRAN and NON, respectively; p<0.001) was significantly higher in the TRAN group. Pelvic sepsis also occurred more frequent in TRAN (22.9 vs 4.2%, TRAN and NON, respectively; p<0.001). The incidence of any infectious complication at any site was higher in anemic patients irrespective of transfusion status (18.2 vs 2.8%, p<0.05). Transfusion was the only significant independent risk factor for postoperative infections. LOS was adversely affected by an infectious complication (9 vs 7 days, p<0.001).
Conclusions
Preoperative anemia is a significant risk factor for perioperative transfusion with significant increase in postoperative infectious complications and anastomotic complications after IPAA. Strategies to correct preoperative anemia, refine indications for transfusion, and define the use of blood salvage techniques may be helpful in decreasing this risk.
Similar content being viewed by others
References
Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41(7):875–882 (discussion 882–883)
Wacha H, Hau T, Dittmer R et al (1999) Risk factors associated with intraabdominal infections: a prospective multicenter study. Peritonitis Study Group. Langenbecks Arch Surg 384(1):24–32
Velasco E, Thuler LC, Martins CA et al (1996) Risk factors for infectious complications after abdominal surgery for malignant disease. Am J Infect Control 24(1):1–6
Rau HG, Mittelkotter U, Zimmermann A et al (2000) Perioperative infection prophylaxis and risk factor impact in colon surgery. Chemotherapy 46(5):353–363
Vamvakas EC, Moore SB (1994) Blood transfusion and postoperative septic complications. Transfusion 34(8):714–727
Blumberg N, Kirkley SA, Heal JM (1996) A cost analysis of autologous and allogeneic transfusions in hip-replacement surgery. Am J Surg 171(3):324–330
Edna TH, Bjerkeset T (1992) Association between blood transfusion and infection in injured patients. J Trauma 33(5):659–661
Triulzi DJ, Vanek K, Ryan DH et al (1992) A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 32(6):517–524
Alexander JW (1991) Transfusion-induced immunomodulation and infection. Transfusion 31(3):195–196
Jensen LS, Kissmeyer-Nielsen P, Wolff B et al (1996) Randomised comparison of leucocyte-depleted versus buffy-coat-poor blood transfusion and complications after colorectal surgery. Lancet 348(9031):841–845
Fazio VW, Ziv Y, Church JM et al (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222(2):120–127
Tartter PI, Quintero S, Barron DM (1986) Perioperative blood transfusion associated with infectious complications after colorectal cancer operations. Am J Surg 152(5):479–482
Tartter PI, Driefuss RM, Malon AM et al (1988) Relationship of postoperative septic complications and blood transfusions in patients with Crohn’s disease. Am J Surg 155(1):43–48
Vamvakas EC, Carven JH (1998) Allogeneic blood transfusion, hospital charges, and length of hospitalization: a study of 487 consecutive patients undergoing colorectal cancer resection. Arch Pathol Lab Med 122(2):145–151
Hill GE, Frawley WH, Griffith KE et al (2003) Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma 54(5):908–914
Kaplan J, Sarnaik S, Gitlin J et al (1984) Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood 64(1):308–310
Kalechman Y, Gafter U, Sobelman D et al (1990) The effect of a single whole-blood transfusion on cytokine secretion. J Clin Immunol 10(2):99–105
Murphy MF (1998) Potential clinical benefits and cost savings of universal leucocyte-depletion of blood components. Transfus Sci 19(4):343–346
Jensen LS (1997) [Use of leukocyte-depleted blood for transfusion]. Ugeskr Laeger 159(34):5073–5076
Baele P (2002) What do we do, and when? The use of blood in clinical practice. Acta Anaesthesiol Belg 53(2):111–117
Titlestad IL, Ebbesen LS, Ainsworth AP et al (2001) Leukocyte-depletion of blood components does not significantly reduce the risk of infectious complications. Results of a double-blinded, randomized study. Int J Colorectal Dis 16(3):147–153
van de Watering LM, Brand A, Houbiers JG et al (2001) Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence. Br J Surg 88(2):267–272
van de Watering LM, Hermans J, Houbiers JG et al (1998) Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial. Circulation 97(6):562–568
D’Amaro J, Houbiers JG, Drijfhout JW et al (1995) A computer program for predicting possible cytotoxic T lymphocyte epitopes based on HLA class I peptide-binding motifs. Hum Immunol 43(1):13–18
Houbiers JG, Brand A, van de Watering LM et al (1994) Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. Lancet 344(8922):573–578
Tang R, Chen HH, Wang YL et al (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 234(2):181–189
Chang H, Hall G, Greets W et al (2000) Allogenic red blood cell transfusion is an independant risk factor for the development of postoperative bacterial infection. Vox Sang 78:13–18
Tadors T, Wobbes T, Hendriks T (1992) Blood transfusion impairs the healing of experimental intestinal anastomosis. Ann Surg 215:276–281
Kapiteijn E, Putter H, van de Velde CJ (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg 89(9):1142–1149
Rebulla P, Dzik WH (1994) Multicenter evaluation of methods for counting residual white cells in leukocyte-depleted red blood cells. The Biomedical Excellence for Safer Transfusion (BEST) Working Party of the International Society of Blood Transfusion. Vox Sang 66(1):25–32
Bengtsson A, Bengtson JP (1996) Autologous blood transfusion: preoperative blood collection and blood salvage techniques. Acta Anaesthesiol Scand 40(8 Pt 2):1041–1056
Vamvakas E (2002) Meta-analysis of randomized controlled trials comparing the risk of postoperative infection between recipients of allogeneic and autologous blood transfusion. Vox Sang 83(4):339–346
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Madbouly, K.M., Senagore, A.J., Remzi, F.H. et al. Perioperative blood transfusions increase infectious complications after ileoanal pouch procedures (IPAA). Int J Colorectal Dis 21, 807–813 (2006). https://doi.org/10.1007/s00384-006-0116-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-006-0116-7