Association Between Intraoperative Blood Transfusions and Early Postoperative Delirium in Older Adults

ArticleinJournal of the American Geriatrics Society 61(3) · March 2013with31 Reads
Impact Factor: 4.57 · DOI: 10.1111/jgs.12143 · Source: PubMed

To determine whether intraoperative blood transfusion, a known trigger and amplifier of inflammation, is an independent risk factor for early postoperative delirium (POD), an acute state of confusion with fluctuating consciousness and inattention after surgery, in older adults undergoing surgery. Secondary analysis using a database created for a prospective cognitive outcomes study. University hospital. Four hundred seventy-two individuals aged 65 and older undergoing major noncardiac surgery. Perioperative data were examined for association with POD on the first postoperative day. Multivariable logistic regression analysis was conducted to determine whether intraoperative blood transfusion independently predicts POD after adjusting for covariates known to be associated with onset of delirium and blood transfusions. One hundred thirty-seven individuals (29%) developed delirium on the first postoperative day. The multivariable logistic regression model identified age, sex, history of central nervous system disorder, preoperative cognitive dysfunction, and pain, as well as blood transfusions, as independent risk factors for POD. Intraoperative administration of more than 1,000 mL of red blood cells (RBCs) was the strongest predictor of POD on the first postoperative day (odds ratio = 3.68; 95% confidence interval = 1.32–10.94; P < .001). Intraoperative blood transfusion of more than 1,000 mL of RBCs increases the risk of delirium on the first postoperative day in older adults undergoing noncardiac surgery.


    • "Besides other complications , e.g. acute lung injury, cardiac overload, immunomodulation, hemolytic reactions and infection, RBC transfusion is also associated with an increased risk of postoperative delirium [36]. Of the 472 patients older than 65 years undergoing noncardiac surgery enrolled in this study, 29% developed delirium on the first postoperative day. "
    [Show abstract] [Hide abstract] ABSTRACT: In this review the different mechanisms of aging and frailty such as DNA defects due to impaired DNA repair, inflammatory processes, disturbances of oxidative phosphorylation are discussed together with mechanisms of cell repair. Components of blood plasma, such as the growth-differentiation protein GDF11, were shown to enhance neurogenesis and to improve the vasculature in the animal cortex and to rejuvenate muscle tissue. Advances in laboratory assays allow to identify plasma proteins that may affect tissue regeneration. This new knowledge from animal research might affect transfusion practice in geriatric patients in the future. Provided it can be translated and confirmed in human research, blood products might no longer be considered only as oxygen carriers or drugs to improve hemostasis. In the present time blood transfusion (RBCs, plasma or platelets) should be directed by differentiated guidelines considering not only cut-off values of hemoglobin, platelet count or coagulation but also old age-specific biologic variation, comorbidities and the clinical context e.g. of bleeding. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Transfusion and Apheresis Science
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    • "ß 2014 Published by Elsevier Ireland Ltd. However, another recent published study has reported that individuals receiving an intraoperative blood transfusion are at high risk for development of early POD (Behrends, DePalma, Sands, & Leung, 2013). Given the conflicting results with regard to the perioperative transfusion strategy on POD development, a randomized controlled trial was undertaken to determine if a restrictive transfusion strategy resulted in any difference in POD in comparison to a liberal transfusion strategy in the aged patients undergoing hip replacement with spinal anesthesia. "
    [Show abstract] [Hide abstract] ABSTRACT: Few studies have examined the association between perioperative blood transfusion and postoperative delirium (POD) in aged patients undergoing total hip replacement surgery. In this prospective study, 186 patients older than 65 yr undergoing elective unilateral total hip replacement surgery were enrolled. Of those, 94 patients were randomly assigned to the restrictive strategy transfusion strategy group, in which red blood cells were transfused in order to maintain 10.0 g/dL > hemoglobin ≧ 8.0 g/dL. Ninety-two patients were randomly assigned to the liberal transfusion strategy group, in which red blood cells were transfused in order to maintain hemoglobin ≧ 10.0 g/dL. POD was diagnosed by confusion assessment method. The baseline characteristics of patients, the length of hospital stay, the incidence of POD, myocardial infarction, stroke, wound infection, pulmonary embolism, and the transfusion volume were recorded. No difference was observed in the baseline characteristics, the length of hospital stay, and the incidence of POD, myocardial infarction, stroke, wound infection, and pulmonary embolism between the two groups (P > 0.05). The proportion of patients transfused with red blood cell and frozen plasma was decreased in the restrictive transfusion group compared with the liberal transfusion group (P < 0.05). In conclusion, restrictive transfusion does not influence the incidence of POD but reduces blood transfusion. Thus, restrictive transfusion may serve as an effective and safe strategy for aged patients following total hip replacement.
    Full-text · Article · Jul 2014 · Archives of gerontology and geriatrics
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    • "Whether intraoperative infusion of preoperative autologous blood or allogeneic blood will influence the postoperative cognitive function to a certain degree, and this mainly depends on the amount of infused blood. More than 1,000 ml of infused blood is considered as the independent risk factor for postoperative delirium [22]. In this study, the autologous blood collection was performed in most patients for a week before operation. "
    [Show abstract] [Hide abstract] ABSTRACT: This study aims to observe the impact of the temperature of blood transfusion and infusion toward the perioperative cerebral oxygen metabolism and the postoperative cognitive recovery. Eighty patients of knee replacement under epidural and general anesthesia were randomly divided into warming blood transfusion and infusion (WBI) group (n = 40) and control group (n = 40). The changes of nasopharyngeal temperature, middle cerebral artery blood flow, CERO2, and SjVO2 of the two groups were recorded at each time point for the assessment of the postoperative overall quality of recovery and cognitive recovery situation. The nasopharyngeal temperatures of the two groups at different time points after transfusion were significantly lower than that at T1, and there was a significant difference between the two groups (P < 0.05). The CERO2 values of the two groups at T3 were significantly higher than at T1, while the SjVO2 values were significantly decreased (P < 0.01). The WBI can significantly reduce the occurrence of the perioperative hypothermia, while it has no significant effect toward cerebral oxygen metabolism, postoperative overall recovery, and recovery of cognitive function.
    Full-text · Article · Feb 2014 · Journal of Orthopaedic Surgery and Research
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