Is homologous blood transfusion a risk factor for infection after hip replacement?

OBJECTIVES To assess the risk of postoperative infection associated with blood transfusion in patients who undergo primary total hip arthroplasty. DESIGN A retrospective cohort study. SETTING Victoria General Hospital, Halifax, (a tertiary-care centre). PATIENTS All patients who underwent primary total hip replacement between 1990 and 1995 (N = 1206). INTERVENTIONS Hip replacement with or without perioperative blood transfusion. OUTCOME MEASURES The rate of postoperative infection, the number of blood transfusions, patient age and sex, duration of surgery and the surgeon who performed the procedure. Victoria General Hospital medical records, the transfusion services record and the Dalhousie University Hip Study databases were integrated and analyzed using a standard statistical package. RESULTS The incidence of infection postoperative was 9.9% overall, 8.4% in patients receiving no transfusion, and 14% in those receiving homologous transfusion (p = 0.035). There were no infections in the 11 patients who received an autologous blood transfusion. Significant predictors of postoperative infection were sex, age and duration surgery; these were not confounding variables multivariate analysis). Neither the operating surgeon nor the blood product transfused affected the infection rate. CONCLUSIONS These findings suggest an increased risk of postoperative infection in patients who undergo primary hip replacement and receive homologous blood transfusions perioperatively.