Plasma Transfusion Is Associated With Postoperative Infectious Complications Following Esophageal Resection Surgery: A Retrospective Cohort Study

ObjectiveTo examine the association between blood component transfusions and the incidence of major postoperative infections in patients undergoing esophageal resection surgery.DesignRetrospective cohort study.SettingSingle academic tertiary referral center.ParticipantsAll patients who underwent esophagectomy from 2005 through 2009.Measurements and Main ResultsThe primary outcome was the incidence of major postoperative infection, defined as pneumonia, bloodstream infection, and/or a surgical site infection occurring within 30 days postoperatively. In total, 465 patients were evaluated. One hundred thirty-eight patients (29.7%) received a blood transfusion before the onset of a major postoperative infection or during a similar exposure interval in those with no such complications. Univariate analysis showed a significant association between any blood component transfusion and postoperative infection (transfused v nontransfused 31.9% v 13.2%; odds ratio = 3.1, 95% confidence interval = 1.9-5.0; p < 0.01). This association was lost on multivariate analysis. Subgroup analysis with multivariate adjustment identified a significant association between high plasma volume blood component transfusions and postoperative infection (odds ratio = 4.2, 95% confidence interval = 1.2-15.8; p = 0.03). With multivariate adjustment, red blood cell administration was no longer associated with major postoperative infectious complications.ConclusionsHigh plasma volume blood component transfusions were associated with the development of major postoperative infectious complications in patients undergoing esophageal resection surgery. In contrast, red blood cell transfusion was not associated with infectious complications.