Fawley J, et al. - Given that perioperative transfusions were associated with higher rate of surgical site infections (SSIs) in neonates, researchers investigated if a similar association also exists among non-neonatal pediatric general surgical patients. Non-newborn pediatric general and thoracic surgery patients showed a higher risk of SSI or wound dehiscence in association with transfusions. Despite a significant interaction between American Society of Anesthesiologists (ASA) classes and transfusion, OR for SSI was stronger for lower ASA classes.

Methods

• An IRB-approved retrospective study was conducted.
• Researchers reviewed non-neonatal patients (age greater than 28 days and less than 18 years) who underwent a general or thoracic surgical procedure in 2012, 2013, 2014, in the American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files.
• Chi-square analyses were used to perform a bivariate analysis comparing proportions of SSI's between patients who received blood transfusion to those who did not.
• The odds of SSIs in transfused vs nontransfused patients were compared via multiple logistic regression analyses controlling for organ failure, steroid use, nutritional status, current infection, American Society of Anesthesiologists (ASA) Physical Status classification, and wound classification.

Results

• The study included 55,133 patients in total; 1,779 patients received blood transfusion (≥25 ml/kg body weight) during or within 72 h of surgery.
• Bivariate analysis showed that transfused patients had at least twice the rate of infection compared to nontransfused patients (p < 0.01): superficial SSI 3.5% vs 1.5%; deep SSI 0.8% vs 0.2%, organ space SSI 3.8% vs 1.6%; deep dehiscence 2% vs 0.3%.
• For transfused patients, total wound infections and dehiscence were 10.5% vs 3.8% in nontransfused patients (p < 0.01).
• As per multiple regression analysis, nutritional issue, current infection, and wounds not classified as “clean” demonstrated statistically significant correlation with SSI.
• Despite significant interaction between ASA and transfusion (p < 0.0001), findings suggested statistically significant associations between transfusions and SSI for ASA class 1–2 (OR = 5.51, 95% CI 3.47–7.52), ASA class 3 (OR = 2.06, 95% CI 1.63–2.61), and ASA class 4–5 (OR = 1.67, 95% CI 1.15–2.42).