Intraoperative blood transfusion predicts postoperative delirium among older patients undergoing elective orthopedic surgery: A prospective cohort study

• Published in: International journal of geriatric psychiatry Vol. 34; no. 6; pp. 881 - 888
• Main Authors: Chou, Ming‐Yueh, Wang, Yu‐Chun, Peng, Li‐Ning, Liang, Chih‐Kuang, Chu, Che‐Sheng, Liao, Mei‐Chen, Lin, Yu‐Te, Hsu, Chien‐Jen, Chen, Liang‐Kung
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2019
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Anemia; Anemia - complications; Anesthesia; Blood transfusion; Blood Transfusion - statistics & numerical data; Blood transfusions; Body mass index; Bone surgery; Cognition; Cohort analysis; Comorbidity; Delirium; Delirium - epidemiology; Delirium - etiology; elective orthopedic surgery; Elective Surgical Procedures - statistics & numerical data; Female; Geriatric psychiatry; Health risk assessment; Humans; Length of Stay - statistics & numerical data; Logistic Models; Male; Malnutrition; Middle Aged; Mood; Odds Ratio; Orthopedic Procedures - statistics & numerical data; Orthopedics; Patients; Postoperative Complications - epidemiology; Prospective Studies; Risk Factors; Surgery; blood transfusion; elective orthopedic surgery; anemia; delirium
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.5086

Objectives To evaluate the roles of preoperative anemia and intraoperative blood transfusion in the development of postoperative delirium among older patients undergoing elective orthopedic surgery. Methods This prospective cohort study recruited subjects aged 60 years old and above who were admitted for elective orthopedic surgery in a tertiary medical center during April 2011 to December 2013. Demographic data (age, gender, body mass index [BMI], and educational level), surgery‐related factors (American Society of Anesthesiology [ASA] class, type of anesthesia and surgery, and intraoperative blood transfusion), results of geriatric assessment (hearing/visual impairment, cognition, depressive mood, comorbidity, malnutrition, polypharmacy, activities of daily living [ADL], and instrumental activities of daily living [IADL]), laboratory data, length of hospital stay, and the development of postoperative delirium were collected for analysis. Results Overall, 461 patients (mean age: 73.5 ± 7.5 years, 42.1% males) were enrolled for study, and 37 (8.0%) of them developed postoperative delirium. We categorized all subjects into four groups based on anemia on admission and blood transfusion during operation or not. Multivariate logistic regression showed that subjects with anemia on admission and received intraoperative blood transfusion were at higher risk of developing postoperative delirium (adjusted odds ratio 3.090; 95% confidence interval [CI], 1.070‐8.926) and those without anemia on admission but received intraoperative blood transfusion were at marginal risk (adjusted odds ratio 2.906; 95% CI, 0.912‐9.259) after adjustment for covariates. Conclusions Anemic older patients receiving intraoperative blood transfusion during operation were at the greatest risk for postoperative delirium when they underwent elective orthopedic surgery. Further intervention study is needed to reduce the risk of postoperative delirium for these patients.