The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome

• Published in: The American journal of surgery 2013-04, Vol.205 (4), p.457-465
• Main Authors: Ferraris, Victor A., M.D., Ph.D, Ballert, Erik Q., M.D, Mahan, Angela, M.D
• Format: Article
• Language: English
• Subjects: Aged; Agreements; Blood; Blood transfusion; Blood transfusions; Chronic obstructive pulmonary disease; Confidence intervals; Databases, Factual; Disease; Erythrocyte Transfusion - adverse effects; Female; Heart attacks; Heart failure; Hospitals; Humans; Hypertension; Intraoperative Care - adverse effects; Logistic Models; Logistics; Male; Middle Aged; Mortality; Multivariate Analysis; Outcome and Process Assessment (Health Care); Postoperative complications; Postoperative Complications - etiology; Postoperative Complications - mortality; Propensity analysis; Propensity Score; Risk Factors; Sepsis; Surgery; Surgical outcomes; Systemic inflammatory response syndrome; Systemic Inflammatory Response Syndrome - etiology; Systemic Inflammatory Response Syndrome - mortality; Values; Variables
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.07.042

Abstract Background Previous observations suggest that intraoperative blood transfusion (IBT) is a risk factor for adverse postoperative outcomes. IBT alters immune function and may predispose to systemic inflammatory response syndrome (SIRS). Methods Patients in the American College of Surgeons National Surgical Quality Improvement Project database were studied over a 5-year period. Logistic regression identified predictors of SIRS. Propensity matching was used to obtain a balanced set of patients with equivalent preoperative risks for IBT. Results Of 553,288 inpatients, 19,968 (3.6%) developed postoperative SIRS, and 40,378 (7.2%) received IBT. Mortality in patients with SIRS was 13-fold higher than in those without SIRS (13.5% vs 1.0%, P < .001). Multivariate analysis identified the amount of blood transfused during IBT as a significant predictor for development of SIRS (odds ratio, 2.2; P < .0001). After propensity matching, 33,507 matched patients with IBT had significantly increased risk for SIRS compared with non-SIRS matched patients (12.0% vs 6.5%, P < .001). Conclusions There is a significant association between IBT and the development of SIRS. IBT may induce SIRS, and reductions in IBT may decrease the incidence of postoperative SIRS.