October 1993

Transfusion Significantly Increases the Risk for Infection After Splenic Injury

Author Affiliations

From the Departments of Surgery (Drs Duke, Schecter, and Horn) and Biostatistics (Mr Modin), Division of Cardiology, San Francisco General Hospital, University of California, San Francisco.

Arch Surg. 1993;128(10):1125-1132. doi:10.1001/archsurg.1993.01420220045006

Objectives:  To determine if splenectomy results in an increased risk for perioperative infection when analyzed against splenic repair and to identify factors associated with perioperative infection, respiratory complication, and admission to the intensive care unit following surgery for splenic trauma.

Design:  Data were collected retrospectively from hospital records and analyzed using stepwise multiple logistic regression.

Setting:  San Francisco (Calif) General Hospital, an urban level 1 trauma center.

Patients:  All patients (n=252) undergoing operation for traumatic splenic injury at San Francisco General Hospital from 1984 through 1990. Patients who died within 24 hours of presentation were excluded from the study.

Main Outcome Measures:  Perioperative infection, respiratory complications, and admission to the intensive care unit.

Results:  Infection rates and the types of organisms yielded in cultures were similar between patients who underwent splenectomy and repair. Gram-negative and gram-positive organisms were found in equal numbers, and in no group did encapsulated organisms predominate. Splenectomy had no independent impact on any of the three outcome measures. Total blood transfusion was found to be the only independently significant variable associated with perioperative infection and respiratory complication. Total blood transfusion of more than 2 U and Injury Severity Score of greater than 25 were independently significantly associated with admission to the intensive care unit.

Conclusions:  The choice between splenectomy and splenic repair does not affect the risk for perioperative infection following injury, whereas blood transfusion significantly increases the risk for perioperative infection, respiratory complication, and admission to the intensive care unit.(Arch Surg. 1993;128:1125-1132)