The effect of universal leukoreduction on postoperative infections and length of hospital stay in elective orthopedic and cardiac surgery

Abstract

Background: A before and after study was undertaken to investigate the effect of universal leukoreduction (ULR) in the UK on postoperative length of hospital stay (LOS) and infections.

Study design and methods: Consecutive patients undergoing elective coronary artery bypass grafting or total hip and/or knee replacement in 11 hospitals received non-WBC-reduced RBCs before implementation of ULR (T1, n=997) or WBC-reduced RBCs after implementation of ULR (T2, n=1098).

Results: Patients in T1 and T2 were comparable except patients in T2 received on average more units of RBCs but had lower discharge Hct levels. Postoperative LOS (T1, 10 +/- 8.9 days; T2, 9.6 +/- 6.9 days) and the proportion of patients with suspected and proven postoperative infections (T1, 21.0%; T2, 20.0%) were unchanged before and after ULR (LOS, hazard ratio 1.01, 95% CI 0.92-1.10; infections, OR 0.83, 95% CI 0.77-1.02). Subgroup analysis showed no significant interaction between storage age or dose of blood on responsiveness of primary outcomes to ULR. Secondary outcomes were unchanged overall. Analysis by surgical procedure gave conflicting results with both increased mortality (p=0.031) and an increased proportion of cardiac patients with proven infections (p=0.004), whereas the proportion of orthopedic patients with proven infections was reduced (p=0.002) after ULR.

Conclusion: Implementation of ULR had no major impact on postoperative infection or LOS in patients undergoing elective surgical procedures who received transfusion(s). Smaller effects, either detrimental or beneficial of ULR, cannot be excluded.