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Blood Transfusion is Associated With Increased Perioperative Surgical Site Infection and Graft Failu
Tze-Woei Tan, MD1, Jeffrey Kalish, MD1, Alik Farber, MD1, Naomi Hamburg, MD1, Robert Eberhardt, MD1, Gheorghe Doros, MD1, Denis Rybin, MD1, Jen Eldrup-Jorgensen, MD2, Philip Goodney, MD3, Jack L. Cronenwett, MD3
1Vascular Study Group of New England, Boston Medical Center, Boston, MA; 2Maine Medical Center, Portland, ME; 3Dartmouth-Hitchcock Medical Center, Lebanon, NH

Background: Packed red blood cell transfusion (TXN) has been postulated to increase morbidity and mortality following cardiac/general surgical operations, but its effects following lower extremity bypass (LEB) have not been studied extensively. While most studies have focused on the perioperative period, long-term effects of TXN have not been elucidated.
Methods: Using the Vascular Study Group of New England database (2003-2010), we examined 2,582 consecutive infrainguinal LEB procedures. Perioperative TXN was categorized as 0units, 1-2units and 3+units. Patients receiving 3+ units were case-matched for age, coronary artery disease, diabetes, and urgency of revascularization with groups of patients receiving 1-2 and 0units. Primary endpoints were perioperative mortality, surgical site infection (SSI), graft patency at discharge, as well as 1-year mortality, SSI, and graft patency.
Results: In the case-matched sample, 514 LEB(63%) received 0units, 194 LEB(23.8%) received 1-2units, and 108LEB(13.2%) received 3+units of packed red blood cells. TXN was associated with significantly higher perioperative SSI and return to the operating room, and significantly lower discharge patency rate. At 1-year, no significant differences existed in mortality, SSI, or graft patency. In multivariate analysis, after controlling for indication (CLI vs. claudication), TXN was still associated with increased perioperative SSI(p<.006) and graft failure at discharge(p<.0001).
Conclusion: Perioperative TXN in patients undergoing LEB is associated with increased SSI and perioperative graft failure. From this observational study, it appears TXN does not have significant long-term consequences, but its detrimental effects in the perioperative period must be weighed carefully against the presumed benefits of blood replacement.


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