Intraoperative Blood Product Transfusion Research Articles

Surgical Site Infection Following Bowel Surgery

We sought to determine whether the administration of preoperative antibiotics, intraoperative transfusion of blood products, and intraoperative hypothermia has any impact on the incidence of postoperative surgical site infections (SSIs) in a heterogeneous patient population undergoing bowel surgery. Retrospective analysis. From September through December 2002, data on 1472 patients undergoing bowel surgery at 31 academic medical centers in the United States were collected. Patients were included in the analysis if they were older than 17 years of age and underwent any surgery involving the small bowel, colon, or rectum. Main Outcome Measure Postoperative SSI. Variables that might affect the risk for developing SSIs were analyzed using multivariate logistic regression analysis. Perioperative transfusion (P = .04; odds ratio, 1.64), and the presence of any infection at the time of surgery (P = .05; odds ratio, 2.46) were independent risk factors for SSI. Patients with a lower intraoperative temperature nadir had a lower risk for SSI (P = .05; odds ratio, 1.33), although this difference is not clinically significant (35.8 degrees C +/- 0.8 degrees C vs 36.0 degrees C +/- 0.9 degrees C, P<.05). There was a trend toward statistical significance for wound class when added to the multivariate model (P = .09; odds ratio, 1.41). The administration of antibiotics within 120 minutes prior to incision or within 120 minutes prior to and 120 minutes after incision had no effect on SSIs in this patient population. This study validates perioperative transfusion as an independent risk factor for SSI. The lack of effectiveness of perioperative antibiotic prophylaxis is surprising because it is discordant with the previous literature, and this finding needs further evaluation.

Hypophosphatemia following open heart surgery: incidence and consequences.

Significant hypophosphatemia (SH) is common after major surgery and may be associated with considerable morbidity, including respiratory and cardiac failure. The contribution of SH to these complications after cardiac surgery is not well defined. In this prospective study, levels of serum phosphorus and other electrolytes (potassium, magnesium and calcium) were measured in 566 consecutive patients (395 men, 182 women; mean age 65.5+/-11.1 years) undergoing elective cardiac surgery at three time points: prior to surgery, immediately on admission to the ICU, and on the first postoperative day. Preoperative (type of surgery, Bernstein-Parsonnet risk estimate), intraoperative (duration of bypass and cross-clamp, intraoperative fluid and blood product use) and postoperative data (duration of ventilation, duration of ICU and hospital stay, requirement for cardioactive drug support, development of atrial fibrillation, and mortality) were collected. Patients were divided into two groups according to the immediate postoperative phosphate level: SH, phosphate <0.48 mmol/l (mean phosphate 0.28+/-0.13 mmol/l, n = 194), and a control group (mean phosphate value 0.84+/-0.08 mmol/l, n = 372). Patients with SH received treatment with sodium or potassium phosphate (0.8 mmol/kg body weight over 6-12 h). SH was present in 34.3% of patients. There were no differences in the baseline characteristics between the two groups. Patients with SH received more intraoperative blood product transfusions. The postoperative course of patients with SH was characterized by prolonged ventilation (2.1+/-1.7 versus 1.1+/-0.9 days, P = 0.05), more patients requiring cardioactive drugs (12-24 h 16 versus 10.9%, P = 0.05 and >24 h 23.5 versus 13.8%, P = 0.05); and a prolonged hospital stay (7.8+/-3.4 versus 5.6+/-2.5 days, P = 0.05). SH was common after open-heart surgery and was associated with an increased incidence of important complications. We suggest that phosphate levels be routinely measured immediately after surgery and appropriate therapy instituted.

Abdominal packing for severe hemorrhage

Background: Diffuse abdominal or retroperitoneal hemorrhage is potentially lethal particularly when associated with coagulopathy, hypothermia, and acidosis. Temporary abdominal packing (PACKS) can control hemorrhage and provide crucial time to correct these physiological and metabolic derangements. Methods: The author reviewed the combined experience of pediatric surgeons at 13 institutions to determine the efficacy of this technique. Results: Twenty-two patients with refractory hemorrhage (ages, 6 days to 20 years) were treated with PACKS. The etiology of hemorrhage was trauma in 13, solid organ tumor bed in four, liver bleeding during necrotizing enterocolitis surgery in two, hemorhagic pancreatitis in one, iliac artery injury while on extracorporeal membrane oxygenation (ECMO) in one, and biliary reconstruction after liver transplant in one. The anatomic site of hemorrhage was the liver or hepatic veins in 14, retroperitoneum or pelvis in seven, and the pancreatic bed in one. Twenty patients (91%) were coagulopathic, hypothermic, and acidotic at the time of packing. Fifteen patients (68%) had PACKS inserted during a primary operative procedure, whereas seven patients (32%) had PACKS inserted during a reexploration for persistent hemorrhage. The mean volume of intraoperative transfusion before PACKS was 190 mL/kg (range, 50 to 600). Primary fascial closure was accomplished in 12 (55%) patients, and temporary skin closure or prosthetic material was used in the other ten. PACKS controlled hemorrhage in 21 of 22 (95%) patients. Removal of PACKS was possible within 72 hours in 18 (82%) patients. No patient experienced rebleeding after PACKS removal; however, two patients died with PACKS in place. An abdominal abscess developed in seven patients (32%); all were successfully drained. Eighteen patients (82%) survived after abdominal packing. Two deaths were caused by multisystem organ failure, one was caused by cardiac failure from uncorrectable cardiac anomalies, and one was from exsanguination after blunt traumatic liver injury. There were no differences in volume of intraoperative blood product transfusion, time to initiate PACKS, physiological status, or type of abdominal closure between survivors and nonsurvivors. Conclusion: The author concludes that temporary abdominal packing can be life saving in children with refractory abdominal or retroperitoneal hemorrhage associated with coagulopathy, hypothermia, and acidosis.