Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery

BACKGROUND: Allogeneic transfusion is associated with postoperative infecti ons that significantly prolong hospital stays and increase costs. Recent st udies suggest that filtering leukocytes from blood prior to transfusion red uces the risk of postoperative infection associated with blood transfusion. We compared the incidence of postoperative infections, hospital stays, and hospital charges of gastrointestinal surgery patients transfused with pack ed red cells or leukocyte-depleted cells. METHODS: Consecutive patients admitted For elective gastrointestinal surger y without previous blood transfusion were randomized to receive routine pac ked red cells or packed red cells filtered to remove leukocytes if transfus ion was required. Multivariate analysis was used to assess the significance of the relationship between leukocyte-depleted blood and postoperative inf ectious complications, postoperative stay, and hospital charges. RESULTS: Fifty-nine (27%) of the 221 patients were transfused. The most sig nificant variable related to transfusion was intraoperative blood loss (P < 0.0001). Followed by admission hematocrit (P <0.0001) and age (P = 0.0022). Infections were noted in 16% of the patients: 11% of untransfused patients , 16% of leukocyte-depleted blood recipients, and 44% of patients transfuse d with packed red cells. Both operative site and nosocomial infections were significantly (P <0.001) more frequent in patients transfused with packed red cells compared with patients transfused with leukocyte-depleted red cel ls. Postoperative stays averaged 9 days for untransfused patients, 12 days for leukocyte-depleted recipients, and 18 days for recipients of packed red cells. Hospital charges were $19,132, $33,954, and $41,002, respectively. Both transfusion and infection were significantly (P <0.001) related to pos toperative stay in multivariate analysis. Hospital charges were significant ly related to postoperative stay (P <0.001), blood loss (P <0.001), age (P <0.001), infection (P = 0.007), and randomization to packed red cells (P = 0.032), CONCLUSIONS: Filtering blood of leukocytes prior to transfusion for electiv e gastrointestinal surgery is associated with lower risk of postoperative i nfection, shorter postoperative stays, and lower hospital charges, Am J Sur g. 1998;176:462-466. (C) 1998 by Excerpta Medica, Inc.