The Impact of Storage Time of Transfused Blood on Postoperative Infectious Complications in Rectal Cancer Surgery

Background: We have studied the impact of storage time of transfused allogeneic blood together with other known risk factors on postoperative infectious complications after operation for rectal cancer. Methods: Intra-abdominal abscess, anastomotic leakage, septicaemia, wound infection, and pneumonia were prospectively recorded in 303 patients undergoing elective resection for primary rectal cancer in 18 Danish hospitals. Patient risk variables and variables related to operation technique and transfusion were recorded prospectively, whereas amount given before infectious complication and storage time of saline-adenine-glucose-mannitol (SAGM) blood, administered to each patient, were recorded retrospectively. Results: The overall infection rate was 24% in 78 non-transfused and 40% in 225 transfused patients (P =0.011). The proportion of SAGM blood stored for >21 days administered to each transfused patient was a median of 60% in patients developing postoperative infections versus 25% (P = 0.037) in patients without infections. A multivariate analysis of significant risk variables showed weight >75 kg (odds ratio, 2.0 versus 21 days (odds ratio, 2.5 versus no transfusion) to be independent variables predicting infectious complications. Conclusion: Blood storage time may, along with other risk factors, play a significant role in blood transfusion-associated development of postoperative infectious complications.