Association between blood transfusion and infections after spinal surgery: a systematic review and meta-analysis

Abstract

Abstract Background Blood transfusion is a crucial replacement therapy in surgery as its side effects on the human immune system may cause postoperative infections. Infections after spinal surgery include surgical site infection (SSI), urinary tract infection (UTI), pneumonia, and sepsis, which have a significant impact on mortality. Whether blood transfusion is a risk factor for postoperative infections in spinal surgery remains unclear. Hence, this meta-analysis aimed to reveal the association between infection after spinal surgery and blood transfusion in clinical trials. Methods PubMed, Embase, Cochrane Library, and Web of Science were explored up to January 31, 2020, for studies related to postoperative infection and spinal surgery. Stata 14.0 was used to pool the estimates with a random-effects model and relative risk (RR) with 95% confidence interval (95% CI) in each study and I-square test to evaluate the heterogeneity. Results Eight cohort studies met the inclusion criteria, comprising a total of 100,989 patients. We found that blood transfusion was significantly associated with postoperative infection (RR = 3.01; 95% CI, 2.74–3.31; p < 0.001) and played a critical role in different types of infections such as SSI, pneumonia, UTI, and sepsis. Conclusion Blood transfusion was a risk factor for postoperative infection in spinal surgery. Hence, efforts should be made to reduce bleeding during the operation, and more restrictive transfusion policies should be followed in the perioperative period. Trial registration This systematic review has been registered in PROSPERO. The registration number is CRD42020193853.