| ObjectiveAllogeneic blood transfusion is the main method to correct perioperative anemia.Surgical site infection(SSI)is an important marker of postoperative morbidity and overall quality of care.Transfusion-related immunomodulation may lead to weakened immunity in response to blood transfusion and predispose patients to SSIs.While facing with the decision whether to transfuse or not,how to balance the benefits of anemia and the potential risk of blood transfusion is one of the most concerned issue for clinicians.The aim of this study was to assess the impact of perioperative blood transfusions on SSIs and dose-response effect of red blood cells,as well as exploring whether autologous blood transfusion can reduce the incidence of surgical site infection and provide evidence for decision-makers based on real-world big data.MethodsRetrospective cohort study was used in the Hospital Quality Monitoring System(HQMS)database authorized by the National Health Commission of the People's Republic of China(including home page medical records of 31 provinces).Patients who were hospitalized in surgery departments and underwent surgeries from 2013 to 2018 in China's tertiary hospitals were included.Two grouping method were used in the study:1)Patients were divided into perioperative any blood transfusion(exposed)group and no transfusion(control)group.2)Patients were divided into perioperative RBCs transfusion(exposed)group and non-RBCs(control)group.SSIs(primary outcome)were compared between 2 groups in both grouping methods.SSI incidence were also compared between whether autologous blood transfusion were used or not in the population of any transfusion and RBCs transfusion to discuss the impact of autotransfuion on SSIs.Secondary outcomes included in-hospital death,hospital infections and length of hospital stay.In addition,RBCs transfusion population was divided into 6 dose groups(0U,>0 and?1U,>1 and?2U,>2 and ?4U,>4 and<8U,>8U)to investigate the dose-response relationship of RBCs transfusions and SSIs.Multiple logistic regression analysis was used to calculate the adjusted odds ratios(ORs)with 95%CIs to identify the independent associations between exposures and outcomes.ResultsA total of 1896584 patients from 29 provinces and regions across the country were included.The mean age of patients was 45.97±20.13,and 57.4%of the population were men.Among them,89629 cases(4.7%)were infused with any blood product perioperatively,and 76078(4.0%)were infused with red blood cells.The average age of perioperative any blood component t:ransfusion group and perioperative RBCs transfusion group were both significantly higher than that of the non-transfusion group.Surgery types were unevenly distributed between transfusion and non-transfusion groups,and ASA grade was higher in perioperative any blood component transfusion group and perioperative RBCs transfusion group.There were more patients diagnosed with anemia and tumors,and people who were transfused had longer operation time,more percentage of clean-contaminated and contaminated incisions,and a higher proportion of general anesthesia.After adjusting for the confounding factors,any blood component transfusion perioperatively statistically significantly increased the risk of SSIs(OR 2.14;95%CI[2.01-2.29],P<0.001).RBCs transfusions perioperatively were also a risk factor for SSIs(OR 2.24;95%CI[2.09-2.40],P<0.001).Autologous blood was a protective factor for SSI in the population with any blood component transfusion(OR 0.29;95%CI[0.18-0.46],P<0.001)and the population with RBCs transfusion(OR 0.52;95%CI[0.30-0.88],P=0.016).After dividing the infusion dose of RBCs into 6 groups(0U,>0 and?U,>1 and ?2U,>2 and ?4U,>4 and<8U,>8U),the ORs of SSI were 1.20(95%CI[0.76-1.91]),1.27(95%CI[1.10-1.47]),1.70(95%CI[1.49-1.93]),2.12(95%CI[1.83-2.45])and 3.65(95%CI[3.13-4.25])respectively,which showed a dose response relationship between RBCs transfusion and SSIs.ConclusionAny transfusion in perioperative period significantly increased the risk of postoperative SSIs.Perioperative RBCs transfusion also increased the risk of SSIs.There were dose-response effect between RBCs transfusion and SSIs.The greater amount of RBCs transfused perioperatively,the higher the incidence of SSIs occurred.Autologous blood transfusions may reduce SSIs in the population of either any transfusion or RBCs transfusion. |
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