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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 4, issue 2
J. Bone Joint Infect., 4, 85–91, 2019
https://doi.org/10.7150/jbji.30001
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 4, 85–91, 2019
https://doi.org/10.7150/jbji.30001
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 16 Mar 2019

Original full-length article | 16 Mar 2019

Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection

Eduard Tornero1, Arturo Pereira2, Misericordia Basora3, Luis Lozano1, Laura Morata4, Ernesto Muñoz-Mahammud1, Andreu Combalia1, and Alex Soriano4 Eduard Tornero et al.
  • 1Department of Traumatology and Orthopedic Surgery, Hospital Clinic of Barcelona. IDIBAPS. Universitat de Barcelona.
  • 2Service of Hemotherapy and Hemostasis, Hospital Clinic of Barcelona
  • 3Service of Anaesthesiology, Hospital Clinic of Barcelona.
  • 4Service of Infectious Diseases. Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS. Barcelona Spain. asoriano@clinic.ub.es

Keywords: red blood cell storage, transfusion, prosthetic joint infection

Abstract. Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused.

Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty between January 2000 and December 2012 were retrospectively reviewed. For this study, only patients who received RBC transfusions during the day of the surgery (early transfusion group) or within the first 4 days after surgery (late transfusion group) were included.

Results: A total of 9906 patients were reviewed. In the early transfusion group (n=1153, 11.6%), patients receiving 1 or 2 RBC units (3.5% vs 6.3%, P=0.041), 3 or 4 RBC (1.3% vs 13.3%, P=0.004) or ≥5 RBC units (5.0% vs 37.5%, P=0.026) had a higher PJI rate only when >50% of RBC units transfused had been stored >14 days. In the late transfusion group (n=920, 9.3%) these differences were not significant. Early transfusion of RBCs stored >14 days was an independent variable associated with an increased risk of PJI (OR:2.50, 95%CI:1.44-4.33)

Conclusion: Transfusion of RBC within the first 6h after joint arthroplasty was an independent variable associated with PJI risk when RBC units are stored >14 days. The rate of PJI increased with the number of old RBC units transfused within this critical period.

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