Impact of intraoperative allogeneic platelet transfusion on healthcare-associated infections in cardiac surgery: insights from a large single-center cohort study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Journal of Cardiothoracic and Vascular Anesthesia Année : 2024

Impact of intraoperative allogeneic platelet transfusion on healthcare-associated infections in cardiac surgery: insights from a large single-center cohort study

Fabrice Cognasse

Résumé

Objectives Despite significant improvement in patient blood management, cardiac surgery remains a high hemorrhagic risk procedure. Platelet transfusion is used commonly to treat thrombocytopenia-associated perioperative bleeding. Allogeneic platelet transfusion may induce transfusion-related immunomodulation. However, its association with postoperative healthcare-associated infections is still a matter of debate. The objective was to evaluate the impact of allogeneic platelet transfusion during cardiac surgery on postoperative healthcare-associated infection incidence. Design Retrospective cohort study. Setting Tertiary referral academic center. Participants Patients undergoing cardiac surgery from 2012 to 2018. Interventions None. Measurements and Main Results Intraoperative platelet transfusion was defined as exposure in a causal model. The primary outcome was the incidence of healthcare-associated infections comprised of bloodstream infection, hospital-acquired pneumonia, and surgical-site infection. Among 7,662 included patients, 528 patients (6.8%) were exposed to intraoperative platelet transfusion, and 329 patients (4.3%) developed 454 postoperative infections. Bloodstream infection affected 106 patients (1.4%), hospital-acquired pneumonia affected 174 patients (2.3%), and surgical-site infection affected 148 patients (1.9%). Intraoperative platelet transfusion was associated with an increased risk of bloodstream infection after adjustment by multivariable logistic regression (odds ratio [OR] 2.85; 95% CI 1.40-5.8; p = 0.004; n = 7,662), propensity score matching (OR 3.95; 95% CI 1.57-12.0), p = 0.007; n = 766), and propensity score overlap weighting (OR 3.04; 95% CI 1.51-6.1, p = 0.002; n = 7,762). Surgical-site infection and hospital-acquired pneumonia were not significantly associated with platelet transfusion. Conclusions These results suggested that intraoperative allogeneic platelet transfusion is a risk factor for bloodstream infection after cardiac surgery. These results supported the development of patient blood management strategies aimed at minimizing perioperative platelet transfusion in cardiac surgery.
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Dates et versions

hal-04564242 , version 1 (30-04-2024)

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Alexandre Mansour, Nicolas Massart, Isabelle Gouin-Thibault, Thibault Seite, Fabrice Cognasse, et al.. Impact of intraoperative allogeneic platelet transfusion on healthcare-associated infections in cardiac surgery: insights from a large single-center cohort study. Journal of Cardiothoracic and Vascular Anesthesia, 2024, ⟨10.1053/j.jvca.2024.02.031⟩. ⟨hal-04564242⟩
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