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The Association Between Perioperative Allogeneic Transfusion Volume and Postoperative Infection in Patients Following Lumbar Spine Surgery

Woods, Barrett I. MD; Rosario, Bedda L. PhD; Chen, Antonia MD; Waters, Jonathan H. MD; Donaldson, William III MD; Kang, James MD; Lee, Joon MD

Journal of Bone & Joint Surgery - American Volume: 4 December 2013 - Volume 95 - Issue 23 - p 2105–2110
doi: 10.2106/JBJS.L.00979
Scientific Articles
Supplementary Content

Background: Perioperative allogeneic red blood cell transfusion is a risk factor for surgical site infection. The purpose of this study was to determine if the volume of perioperative allogeneic red blood cell transfusion influences the risk of surgical site infection following lumbar spine procedures.

Methods: A retrospective matched case control study was performed by reviewing all patients who had undergone lumbar spine surgery at our institution from 2005 to 2009. Surgical site infections (spinal or iliac crest) were identified, all within thirty days of the procedure. Controls were matched to the infection cohort according to age, sex, body mass index, diabetic status, smoking status, Charlson Comorbidity Index, length of surgery, and procedure. A conditional logistic regression was performed to examine the association between transfusion volume and surgical site infection. The results were summarized by an odds ratio.

Results: A total of 1799 lumbar procedures were identified with an infection rate of 3.1% (fifty-six cases). On the basis of the numbers, there was no significant difference in the matched variables between the infection cohort and the matched controls. The volume of transfusion was significantly associated with surgical site infection (odds ratio, 4.00 [95% confidence interval, 1.96 to 8.15]) after adjusting for both unmatched variables of preoperative hemoglobin level and volume of intraoperative blood loss.

Conclusions: In this retrospective matched case control study, the association between surgical site infection following lumbar spine surgery and volume of perioperative allogeneic red blood cell transfusion was supported.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Departments of Orthopaedic Surgery (B.I.W., A.C., W.D., J.K., and J.L.), Epidemiology (B.L.R.), and Anesthesiology (J.H.W.), University of Pittsburgh Medical Center, Kaufmann Medical Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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