Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer

Objective - To assess the effect of blood transfusion on the development of infection after elective operations for gastrointestinal and pancreatic cancer. Design - Prospective open study. Subjects - 285 consecutive patients admitted with gastric, colorectal, and pancreatic cancer, 215 of whom were suitable for the study. Main outcome measures - Sex, age, total iron binding capacity, measurement of haemoglobin and serum albumin concentration, assessment of immune response by delayed hypersensitivity skin test, and weight loss were recorded, as were duration of operation, operative blood loss, and pathological TNM stage of the disease. Results - Sixty patients (28%) developed infections postoperatively. Univariate analysis showed that the development of infection was significantly associated with the amount of blood transfused (p < 0.001), operative blood loss (p < 0.05), and length of operation (p < 0.01), but not weight loss (p = 0.07) or delayed hypersensitivity response (p = 0.08). Multiple logistic analysis showed that blood transfusion was a significant independent variable only when more than 1,000 ml were transfused (odds ratio 6.5, p < 0.05). Conclusion - Transfusion of more than 1,000 ml of blood is an independent risk factor in the development of infection postoperatively in patients undergoing operations for gastrointestinal cancer.