The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome

BACKGROUND: Previous observations suggest that intraoperative blood transfusion (IBT) is a risk factor for adverse postoperative outcomes. IBT alters immune function and may predispose to systemic inflammatory response syndrome (SIRS). METHODS: Patients in the American College of Surgeons National Surgical Quality Improvement Project database were studied over a 5-year period. Logistic regression identified predictors of SIRS. Propensity matching was used to obtain a balanced set of patients with equivalent preoperative risks for IBT. RESULTS: Of 553,288 inpatients, 19,968 (3.6%) developed postoperative SIRS, and 40,378 (7.2%) received IBT. Mortality in patients with SIRS was 13-fold higher than in those without SIRS (13.5% vs 1.0%, P < .001). Multivariate analysis identified the amount of blood transfused during IBT as a significant predictor for development of SIRS (odds ratio, 2.2; P < .0001). After propensity matching, 33,507 matched patients with IBT had significantly increased risk for SIRS compared with non-SIRS matched patients (12.0% vs 6.5%, P < .001). CONCLUSIONS: There is a significant association between IBT and the development of SIRS. IBT may induce SIRS, and reductions in IBT may decrease the incidence of postoperative SIRS. (C) 2013 Elsevier Inc. All rights reserved.