Does intraoperative cell salvage reduce postoperative infection rates in cardiac surgery?

Objective: Primary outcome was the risk for infections after cell salvage in cardiac surgery. Design: Data of a randomized controlled trial on cell salvage and filter use (ISRCTN58333401). Setting: Six cardiac surgery centers in the Netherlands. Participants: All 716 patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures over a 4-year period who completed the trial. Interventions: Postoperative infection data were assessed according to Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions. Measurements and Main Results: Fifty-eight (15.9%) patients with cell salvage had infections, compared with 46 (13.1%) control patients. Mediation analysis was performed to estimate the direct effect of cell salvage on infections (OR 2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic transfusion and processed cell salvage blood on infections. Correction for confounders, including age, seks and body mass index was performed. Allogeneic transfusion had a direct effect on infections (OR = 2.082 [1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR = 0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p < 0.001), but a negative direct effect of processed cell salvage blood (1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there was a positive direct effect of cell salvage on the amount of processed blood. Conclusions: Cell salvage was directly associated with higher infection rates, but this direct effect was almost completely eliminated by its indirect protective effect through reduced allogeneic blood transfusion.