Perioperative Allogeneic Blood Transfusion Is Associated With Surgical Site Infection After Abdominoperineal Resection-a Space for the Implementation of Patient Blood Management Strategies

Abstract

Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing colorectal surgery. However, the association of ABT with SSI in patients undergoing abdominoperineal resection (APR) and total pelvic exenteration (TPE) still remains to be evaluated. Here, we aim to elucidate this association. The medical records of all patients undergoing APR and TPE at our institution in the period between January 2000 and December 2012 were reviewed. Patients without SSI (no SSI group) were compared with patients who developed SSI (SSI group), in terms of clinicopathologic features, including ABT. In addition, data for 262 patients who underwent transabdominal rectal resection at our institution in the same period were also enrolled, and their data on differential leukocyte counts were evaluated. Multivariate analysis showed that intraoperative transfusion was an independent predictive factor for SSI after APR and TPE (P = 0.004). In addition, the first-operative day lymphocyte count of patients undergoing APR, TPE, and transabdominal rectal resection was significantly higher in nontransfusion patients compared with transfusion ones (P = 0.026). ABT in the perioperative period of APR and TPE may have an important immunomodulatory effect, leading to an increased incidence of SSI. This fact should be carefully considered, and efforts to avoid allogeneic blood exposure while still achieving adequate patient blood management would be very important for patients undergoing APR and TPE as well.

Keywords: Abdominoperineal resection; Allogeneic blood transfusion; Colorectal cancer; Patient blood management; Surgical site infection.

Fig. 1

No significant difference was observed in the DFS rates (a) and the OS rates (b) of the non-SSI and the SSI groups. When comparing the DFS rates (c) and the OS rates (d) of the non-ABT and ABT groups, the non-ABT group had a significantly improved DFS rate.

Fig. 2

Perioperative neutrophil and lymphocyte counts in 233 rectal surgery patients. Patients were divided into non-ABT and ABT groups, and the preoperative neutrophil counts (a) and lymphocyte counts (b), as well as the POD1 neutrophil counts (c) and lymphocyte counts (d), were analyzed. The POD1 lymphocyte counts (d) were significantly lower in the ABT group compared with the non-ABT group. There was no significant difference between ABT and non-ABT related to preoperative neutrophil (a) and lymphocyte (b) counts, or the POD1 neutrophil counts (c).