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Allogeneic Blood Transfusions and Postoperative Infections After Total Hip or Knee Arthroplasty

Friedman, Richard MD, FRCSC; Homering, Martin MSPH; Holberg, Gerlind DVM, PhD; Berkowitz, Scott D. MD

Journal of Bone & Joint Surgery - American Volume: 19 February 2014 - Volume 96 - Issue 4 - p 272–278
doi: 10.2106/JBJS.L.01268
Scientific Articles
Disclosures

Background: Up to 70% of patients who undergo total hip or total knee arthroplasty receive blood transfusions. Using data from more than 12,000 patients assessed in the Phase-III RECORD (Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism) studies, we investigated whether allogeneic blood transfusion increases the risk of postoperative infection compared with autologous blood transfusion or no transfusion.

Methods: A post hoc analysis of the pooled RECORD data stratified patients into three groups according to the type of blood transfusion that they received: no transfusion (n = 6313), autologous blood transfusion (n = 1902), and allogeneic blood transfusion with or without autologous blood transfusion (n = 3962). The types of postoperative infection were recorded and included lower or upper respiratory tract and lung infection, bone and joint infection, wound inflammation or infection, urinary tract infection, and other infections.

Results: The rates of infection in patients receiving no transfusion or autologous blood transfusion were similar; therefore, data from these two groups were combined. The rate of any infection was 9.9% (392 of 3962) in patients receiving allogeneic blood transfusion and 7.9% (646 of 8215) in patients not receiving allogeneic blood transfusion with or without autologous blood transfusion (p = 0.003). The rates of lower or upper respiratory tract and lung infection (2.1% [eighty-five of 3962] versus 1.3% [109 of 8215]; p = 0.002) and of wound inflammation or infection (2.4% [ninety-four of 3962] versus 1.7% [138 of 8215]; p = 0.046) were significantly higher in patients receiving allogeneic blood transfusion compared with patients not receiving allogeneic blood transfusion. When comparing patients who had received allogeneic blood transfusion with those who had not received allogeneic blood transfusion, the rates of bone and joint infection (0.4% [fourteen of 3962] versus 0.2% [eighteen of 8215]; p = 0.056), of urinary tract infection (3.1% [123 of 3962] versus 2.5% [209 of 8215]; p = 0.551), and of other infections (3.0% [120 of 3962] versus 2.7% [225 of 8215]; p = 0.308) were not significantly different.

Conclusions: The rates of any infection, lower or upper respiratory tract and lung infection, and wound inflammation or infection were significantly increased after elective total hip or total knee arthroplasty in patients receiving allogeneic blood transfusion compared with those receiving autologous blood transfusion or no blood transfusion.

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

1Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston Orthopaedic Associates, 1012 Physicians Drive, Charleston, SC 29414. E-mail address: rjfriedman@mybones.com

2Bayer Pharma AG, Aprather Weg 18a, 42096 Wuppertal, Germany

3Bayer Pharma AG, Müllerstrasse 178, 13342 Berlin, Germany

4Bayer HealthCare Pharmaceuticals, PO Box 1000, Montville, NJ 07045

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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