From the Guidelines
Excessive bleeding during surgery significantly increases the risk of infection by compromising the body's natural defense mechanisms, and managing surgical bleeding through meticulous hemostasis, proper surgical technique, and maintaining normal body temperature is crucial to reduce this risk. When substantial blood loss occurs, it depletes the patient's immune cells and proteins that fight pathogens, weakening overall immune function 1. The blood that accumulates in surgical sites creates an ideal environment for bacterial growth, essentially serving as a culture medium. Additionally, severe bleeding often necessitates blood transfusions, which can temporarily suppress immune function through a phenomenon called transfusion-related immunomodulation 1. Prolonged operations due to bleeding management give microorganisms more opportunity to enter the surgical site. The decreased tissue perfusion from blood loss means less oxygen and fewer immune cells reach the surgical area, impairing wound healing and reducing the body's ability to combat potential infections.
Some key factors that contribute to the increased risk of infection due to excessive bleeding include:
- Depletion of immune cells and proteins
- Creation of an ideal environment for bacterial growth
- Need for blood transfusions, which can suppress immune function
- Prolonged operations, allowing more time for microorganisms to enter the surgical site
- Decreased tissue perfusion, impairing wound healing and immune function
According to recent guidelines, surgical site infections (SSIs) are a significant healthcare quality issue, resulting in increased morbidity, disability, length of stay, mortality, resource utilization, and costs 1. The primary therapy for SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention 1. However, the use of subcutaneous drains to prevent wound infection is not recommended routinely, as high-quality evidence systematic reviews and meta-analyses demonstrate that it does not confer any advantage in preventing postoperative wound infection 1.
Overall, managing surgical bleeding effectively is essential to reduce the risk of infection and improve patient outcomes, and this can be achieved through meticulous hemostasis, proper surgical technique, and maintaining normal body temperature 1.
From the Research
Relationship Between Excessive Bleeding and Infection Risk in Surgery
- Excessive bleeding during surgery can lead to an increased risk of infection due to several factors, including the need for blood transfusions and the potential for compromised immune function 2.
- Blood transfusions, in particular, have been shown to increase the risk of surgical site infections (SSIs) in patients undergoing bariatric surgery, with organ space SSIs being the most prevalent type 2.
- The immune system's response to blood transfusion, known as transfusion-related immunomodulation, can weaken the body's defenses and make it more susceptible to infection 2.
Mechanisms Underlying the Increased Risk of Infection
- Uncontrolled bleeding can lead to a combination of hemodilution, hypothermia, consumption of clotting factors, and acidosis, which can worsen the clotting process and create a vicious cycle of bleeding and coagulopathy 3.
- This can result in the need for blood-derived products and hemostatic agents, which can further increase the risk of infection and other complications 3.
- The use of fresh frozen plasma, vitamin K, and platelet transfusions can help to arrest the progression of bleeding and reduce the risk of infection, as seen in a case study of a patient taking anticoagulant and antiplatelet agents 4.
Strategies for Reducing the Risk of Infection
- The use of tranexamic acid, prothrombin complex concentrate, and fresh frozen plasma can help to improve hemostatic balance and reduce the risk of bleeding and infection 5.
- Close monitoring of postoperative signs of infection is important, particularly in patients who have received blood transfusions, to determine if additional interventions are warranted 2.
- Further research is needed to fully understand the relationship between excessive bleeding, blood transfusions, and the risk of infection in surgical patients, and to develop effective strategies for reducing this risk 2.