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

doi:10.1002/gps.5086

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Title:	Intraoperative blood transfusion predicts postoperative delirium among older patients undergoing elective orthopedic surgery: A prospective cohort study
Authors:	Ming-Yueh Chou(周明岳) Wang, Yu-Chun Peng, Li-Ning Liang, Chih-Kuang Chu, Che-Sheng Liao, Mei-Chen Lin, Yu-Te Hsu, Chien-Jen Liang-Kung Chen(陳亮恭)
Contributors:	Kaohsiung Vet Gen Hosp, Ctr Geriatr & Gerontol Natl Yang Ming Univ, Aging & Hlth Res Ctr Natl Yang Ming Univ, Sch Med, Dept Geriatr Med Chia Nan Univ Pharm & Sci Taipei Vet Gen Hosp, Ctr Geriatr & Gerontol Kaohsiung Vet Gen Hosp, Div Neurol, Dept Med Kaohsiung Vet Gen Hosp, Dept Psychiat Kaohsiung Vet Gen Hosp, Dept Orthoped
Keywords:	anemia blood transfusion delirium elective orthopedic surgery
Date:	2019-06
Issue Date:	2020-07-29 13:47:41 (UTC+8)
Publisher:	WILEY
Abstract:	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.
Relation:	International Journal of Geriatric Psychiatry, v.34, n.6, pp.881-888
Appears in Collections:	[Dept. of Pharmacy] Periodical Articles

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