Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients

BACKGROUND: Allogeneic blood transfusions have been reported to increase su sceptibility to postoperative infection, but the findings were inconclusive . This study was designed to investigate the effect of buffy coat-depleted allogeneic and autologous transfusion on postoperative infection in patient s undergoing orthopedic surgery. STUDY DESIGN AND METHODS: Patients (n = 385) undergoing elective orthopedic surgery (primary and revision joint replacement, spinal, or pelvic surgery ) were included in a prospective observational study of the incidence of po stoperative infection between April and December 1996. Infection rates in p atients who received allogeneic buffy coat-depleted brood transfusions were compared with those in patients who received no transfusion or only autolo gous (buffy coat-depleted) blood. RESULTS: Patients without exposure to allogeneic blood (no blood or only au tologous blood) bad an infection rate of 3.9 percent, as compared to a rate of 12.2 percent for those with exposure to allogeneic blood (allogeneic br ood, autologous plus allogeneic blood) (odds ratio 3.442; 95% CI, 1.349-10. 40; p = 0.006). Of the 385 study patients, 309 underwent primary hip or kne e replacement surgery. In this homogeneous subgroup, the postoperative infe ction rate was 4.6 percent after no transfusion or autologous transfusion a nd 11.9 percent after allogeneic transfusion (odds ratio 2.827; 95% CI 1.05 9-8.799; p = 0.036). Multivariate regression analysis confirmed buffy coat- depleted allogeneic blood transfusion as an independent variable associated with high risk for postoperative infection. CONCLUSION: Buffy coal-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.