Blood transfusions during bypass surgery linked with increase in infections


ANN ARBOR, Mich. - A study of almost 25,000 coronary artery bypass graft patients shows receiving blood from another person is associated with a two-fold increase in post-operative infection rates.

The research, published July 31 in BMC Medicine, alsofound considerable variation in ways hospitals use blood transfusions.
 "Clearly, blood transfusions are vital in the treatment of some conditions, such as life-threatening bleeding," says Mary A.M. Rogers, Ph.D., M.S., assistant professor in internal medicine at the University of Michigan and research director of the Patient Safety Enhancement Program at the U-M Health System and the Ann Arbor VA Medical Center.
"However, over the past several decades a body of evidence has accumulated that indicates various adverse effects in patients who receive transfusions, particularly with exposure to allogeneic blood."
According to the American Heart Association, CABG is one of the most common ways to improve blood flow to the heart and works by re-routing the blood supply, or bypassing a clogged section of the artery.
Surgery reduces the risk of heart attack, improves ability to be physically active and relieves chest pain, however large amounts of stored blood may be transfused during the two- to six-hour surgery.
The researchers sought to assess hospital variation in blood use and outcomes in cardiac surgery patients, to see if unnecessary blood transfusions may be putting the safety of some patients at risk.
Overall, 30 percent of the variation in transfusion practices was found to be attributable to the hospital where the CABG was performed.
"The safety of patients undergoing CABG will likely be improved if hospitals carefully review current guidelines on allogeneic blood transfusion, closely adhere to such guidelines, and institute interventions to reduce inappropriate use of blood transfusions in recipients of CABG," Rogers says
Additional authors: Neil Blumberg,  Sanjay Saint, M.D., MPH ,  Kenneth Langa, M.D.,  and  Brahmajee K. Nallamothu, M.D., MPH .
Funding: Blue Cross Blue Shield of Michigan Foundation. The funding agency had no role in the design or conduct of the study, nor preparation or review of the manuscript.
Reference: BMC Medicine 2009, 7:37

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