Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection

Eduard Tornero; Arturo Pereira; Misericordia Basora; Luis Lozano; Laura Morata; Ernesto Muñoz-Mahamud; Andreu Combalia; Alex Soriano

doi:10.7150/jbji.30001

Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection

J Bone Jt Infect. 2019 Mar 16;4(2):85-91. doi: 10.7150/jbji.30001. eCollection 2019.

Authors

Eduard Tornero¹, Arturo Pereira², Misericordia Basora³, Luis Lozano¹, Laura Morata⁴, Ernesto Muñoz-Mahamud¹, Andreu Combalia¹, Alex Soriano⁴

Affiliations

¹ Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona.
² Service of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona.
³ Service of Anaesthesiology, Hospital Clinic of Barcelona.
⁴ Service of Infectious Diseases. Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS. Barcelona Spain. asoriano@clinic.ub.es.

Abstract

Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused. Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty between January 2000 and December 2012 were retrospectively reviewed. For this study, only patients who received RBC transfusions during the day of the surgery (early transfusion group) or within the first 4 days after surgery (late transfusion group) were included. Results: A total of 9906 patients were reviewed. In the early transfusion group (n=1153, 11.6%), patients receiving 1 or 2 RBC units (3.5% vs 6.3%, P=0.041), 3 or 4 RBC (1.3% vs 13.3%, P=0.004) or ≥5 RBC units (5.0% vs 37.5%, P=0.026) had a higher PJI rate only when >50% of RBC units transfused had been stored >14 days. In the late transfusion group (n=920, 9.3%) these differences were not significant. Early transfusion of RBCs stored >14 days was an independent variable associated with an increased risk of PJI (OR:2.50, 95%CI:1.44-4.33) Conclusion: Transfusion of RBC within the first 6h after joint arthroplasty was an independent variable associated with PJI risk when RBC units are stored >14 days. The rate of PJI increased with the number of old RBC units transfused within this critical period.

Keywords: prosthetic joint infection; red blood cell storage; transfusion.