The Impact of Blood Transfusion in Developing Postoperative Delirium in Patients with Hip Fracture Surgery

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Jul 29

PMID 37510810

Authors

Sang-Soo Lee

Jong-Ho Kim

Jae-Jun Lee

Young-Suk Kwon

Eun-Min Seo

Affiliations

Soon will be listed here.

Abstract

Background: Many studies have been conducted to explore the risk factors associated with postoperative delirium (POD) in order to understand its underlying causes and develop prevention strategies, especially for hip fracture surgery. However, the relationship between blood transfusion and POD has been heatedly debated. The purpose of this study was to evaluate the risk factors of POD and the relationship between blood transfusions and the occurrence of POD in hip fracture surgery through big data analysis.

Methods: Medical data (including medication history, clinical and laboratory findings, and perioperative variables) were acquired from the clinical data warehouse (CDW) of the five hospitals of Hallym University Medical Center and were compared between patients without POD and with POD.

Results: The occurrence of POD was 18.7% (228 of 2398 patients). The risk factors of POD included old age (OR 4.38, 95% CI 2.77-6.91; < 0.001), American Society of Anesthesiology physical status > 2 (OR 1.84 95% CI 1.4-2.42; < 0.001), dementia (OR 1.99, 95% CI 1.53-2.6; < 0.001), steroid (OR 0.53 95% CI 0.34-0.82; < 0.001), Antihistamine (OR 1.53 95% CI 1.19-1.96; < 0.001), and postoperative erythrocyte sedimentation rate (mm/h) (OR 0.97 95% CI 0.97-0.98; < 0.001) in multivariate logistic regression analysis. The postoperative transfusion (OR 2.53, 95% CI 1.88-3.41; < 0.001) had a significant effect on the incidence of POD.

Conclusions: big data analytics using a CDW was a good option to identify the risk factors of POD and to prevent POD in hip fracture surgery.

Citing Articles

Optimization of the cardiac delirium index by including age, decrease in butyrylcholinesterase actitivity, preoperative HbA1c, and postoperative hemoglobin levels: results of a secondary analysis of a prospective observational study.

Zajonz T, Edinger F, Markmann M, Grab K, Sander M, Kunzemann C Front Cardiovasc Med. 2024; 11:1459268.

PMID: 39713214 PMC: 11659291. DOI: 10.3389/fcvm.2024.1459268.

Perioperative Blood Transfusion and Delirium after Total Knee or Hip Arthroplasty: Retrospective Analysis.

Kim S, Oh T, Song I J Pers Med. 2024; 14(6).

PMID: 38929797 PMC: 11204434. DOI: 10.3390/jpm14060576.

Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique.

Hu W, Bai G, Wang Y, Hong D, Jiang J, Li J World J Gastrointest Oncol. 2024; 16(4):1227-1235.

PMID: 38660665 PMC: 11037067. DOI: 10.4251/wjgo.v16.i4.1227.

References

Marcantonio E, Goldman L, Orav E, Cook E, Lee T . The association of intraoperative factors with the development of postoperative delirium. Am J Med. 1998; 105(5):380-4. DOI: 10.1016/s0002-9343(98)00292-7. View

Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W . Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. J Int Med Res. 2016; 44(2):317-27. PMC: 5580064. DOI: 10.1177/0300060515624936. View

Bilotta F, Lauretta M, Borozdina A, Mizikov V, Rosa G . Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013; 79(9):1066-76. View

Musallam K, Tamim H, Richards T, Spahn D, Rosendaal F, Habbal A . Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011; 378(9800):1396-407. DOI: 10.1016/S0140-6736(11)61381-0. View

Aiello G, Cuocina M, La Via L, Messina S, Attaguile G, Cantarella G . Melatonin or Ramelteon for Delirium Prevention in the Intensive Care Unit: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2023; 12(2). PMC: 9863078. DOI: 10.3390/jcm12020435. View

Zhang W, Wu W, Gu J, Sun Y, Ye X, Qiu W . Risk factors for postoperative delirium in patients after coronary artery bypass grafting: A prospective cohort study. J Crit Care. 2015; 30(3):606-12. DOI: 10.1016/j.jcrc.2015.02.003. View

Behrends M, DePalma G, Sands L, Leung J . Association between intraoperative blood transfusions and early postoperative delirium in older adults. J Am Geriatr Soc. 2013; 61(3):365-70. PMC: 4529289. DOI: 10.1111/jgs.12143. View

Amin R, DeMario V, Best M, Shafiq B, Hasenboehler E, Sterling R . A Restrictive Hemoglobin Transfusion Threshold of Less Than 7 g/dL Decreases Blood Utilization Without Compromising Outcomes in Patients With Hip Fractures. J Am Acad Orthop Surg. 2019; 27(23):887-894. DOI: 10.5435/JAAOS-D-18-00374. View

Chrispal A, Mathews K, Surekha V . The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India. J Assoc Physicians India. 2010; 58:15-9. View

10.

Qiu Y, Huang X, Huang L, Tang L, Jiang J, Chen L . 5-HT(1A) receptor antagonist improves behavior performance of delirium rats through inhibiting PI3K/Akt/mTOR activation-induced NLRP3 activity. IUBMB Life. 2016; 68(4):311-9. DOI: 10.1002/iub.1491. View

11.

Fineberg S, Nandyala S, Marquez-Lara A, Oglesby M, Patel A, Singh K . Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine (Phila Pa 1976). 2013; 38(20):1790-6. DOI: 10.1097/BRS.0b013e3182a0d507. View

12.

Shi C, Yang C, Gao R, Yuan W . Risk Factors for Delirium After Spinal Surgery: A Meta-Analysis. World Neurosurg. 2015; 84(5):1466-72. DOI: 10.1016/j.wneu.2015.05.057. View

13.

Gao R, Yang Z, Li M, Shi Z, Fu Q . Probable risk factors for postoperative delirium in patients undergoing spinal surgery. Eur Spine J. 2008; 17(11):1531-7. PMC: 2583180. DOI: 10.1007/s00586-008-0771-1. View

14.

Dasgupta M, Dumbrell A . Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006; 54(10):1578-89. DOI: 10.1111/j.1532-5415.2006.00893.x. View

15.

Tan H, Bi J, Wang Y, Zhang J, Zuo Z . Transfusion of Old RBCs Induces Neuroinflammation and Cognitive Impairment. Crit Care Med. 2015; 43(8):e276-86. PMC: 4506264. DOI: 10.1097/CCM.0000000000001023. View

16.

Zhu C, Yin J, Wang B, Xue Q, Gao S, Xing L . Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients: A systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(32):e16795. PMC: 6708976. DOI: 10.1097/MD.0000000000016795. View

17.

Brooks P . Postoperative delirium in elderly patients. Am J Nurs. 2012; 112(9):38-49. DOI: 10.1097/01.NAJ.0000418922.53224.36. View

18.

Dodd A, Bulka C, Jahangir A, Mir H, Obremskey W, Sethi M . Predictors of 30-day mortality following hip/pelvis fractures. Orthop Traumatol Surg Res. 2016; 102(6):707-10. DOI: 10.1016/j.otsr.2016.05.016. View

19.

Huang J, Bin Abd Razak H, Yeo S . Incidence of postoperative delirium in patients undergoing total knee arthroplasty-an Asian perspective. Ann Transl Med. 2017; 5(16):321. PMC: 5566723. DOI: 10.21037/atm.2017.06.40. View

20.

van der Zanden V, Beishuizen S, Scholtens R, de Jonghe A, de Rooij S, van Munster B . The Effects of Blood Transfusion on Delirium Incidence. J Am Med Dir Assoc. 2016; 17(8):748-53. DOI: 10.1016/j.jamda.2016.04.008. View