PD8-06 PERIOPERATIVE BLOOD TRANSFUSIONS AS A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER UROLOGIC SURGERY

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-06 PERIOPERATIVE BLOOD TRANSFUSIONS AS A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER UROLOGIC SURGERY Richard Matulewicz, Daniel Oberlin, Irene Helenowski, Borko Jovanovic, and Shilajit Kundu Richard MatulewiczRichard Matulewicz More articles by this author , Daniel OberlinDaniel Oberlin More articles by this author , Irene HelenowskiIrene Helenowski More articles by this author , Borko JovanovicBorko Jovanovic More articles by this author , and Shilajit KunduShilajit Kundu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.921AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have associated perioperative blood transfusions (BT) with significantly increased postoperative infection rates. The effect of BT on infection appears to be related to the state of immunosuppression it induces. We investigated the risk of short-term post-operative infectious outcomes of urologic surgery with perioperative BT. METHODS We identified patients undergoing the thirty most common urologic surgeries captured by the ACS-NSQIP database from 2006 to 2012. The association of preoperative and intraoperative/post operative transfusions with infectious outcomes (surgical site infections (SSI), urinary tract infection (UTI), pneumonia, sepsis/septic shock) was assessed by Chi-square test with continuity correction. Multivariate logistic regression controlling for diabetes, chronic steroid use, recent chemotherapy, and operative wound classification provided odds ratios for infectious outcomes. RESULTS A total of 41,858 cases of the 30 most common urologic operations were reviewed. 30,651 (73.2%) cases met inclusion criteria for review. 0.5% (157/30651) of patients had a transfusion of at least 1 unit of packed red blood cells (pRBC) within 72 hours prior to surgery. 3.7% (1133/30651) of patients received a BT of at least 1 unit pRBC intraoperatively or within 72 hours postoperatively. Multivariate analysis, controlling for potential confounding risks factors, found that preoperative transfusion is associated with a significantly increased risk of pneumonia, UTI, and post-operative sepsis (p<0.01, Table 1). Intraoperative and post-operative transfusion is associated with both superficial and deep SSI, organ space infection, UTI, and post-operative sepsis, including septic shock (p <0.01). CONCLUSIONS Although blood transfusions are beneficial in select patients with perioperative anemia, our study shows that BT is associated with a significantly increased risk of post-operative infectious complications. We found an increase risk of SSI, pneumonia, and sepsis among transfused patients undergoing urologic surgery. Prudent use of BT can potentially mitigate infectious complications. Transfusion Timing Infectious Outcome Odds Ratio Confidence Interval (95%) p value Preoperative Pneumonia 4.0 1.4-11.0 < 0.01 UTI 2.2 1.2-4.1 0.01 Postop Sepsis 2.9 1.2-7.2 0.02 Intraoperative/Postoperative Superficial SSI 4.7 3.2-6.9 < 0.01 Deep SSI 5.4 2.5-11.5 < 0.01 Organ Space Infection 8.0 5.1-12.7 < 0.01 Pneumonia 6.7 4.6-9.8 < 0.01 UTI 1.9 1.5-2.5 < 0.01 Postop Sepsis 6.4 4.8-8.7 < 0.01 Postop Septic Shock 5.6 3.3-9.6 < 0.01 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e192 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard Matulewicz More articles by this author Daniel Oberlin More articles by this author Irene Helenowski More articles by this author Borko Jovanovic More articles by this author Shilajit Kundu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...