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

Objectives 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...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2013-03, Vol.61 (3), p.365-370
Main Authors: Behrends, Matthias, DePalma, Glen, Sands, Laura, Leung, Jacqueline
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Aged
Aged, 80 and over
Aging
Biological and medical sciences
Blood transfusions
Central nervous system
Delirium
Delirium - epidemiology
Delirium - etiology
Female
General aspects
Historical account
Hospitals
Humans
Intraoperative Care - adverse effects
Logistic Models
Male
Medical sciences
Mental disorders
Miscellaneous
Multivariate Analysis
Older people
Organic mental disorders. Neuropsychology
Postoperative period
Prospective Studies
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
San Francisco - epidemiology
Secondary analysis
Surgery
Transfusion
Transfusion Reaction
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Summary:Objectives 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. Design Secondary analysis using a database created for a prospective cognitive outcomes study. Setting University hospital. Participants Four hundred seventy‐two individuals aged 65 and older undergoing major noncardiac surgery. Measurements 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. Results 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 
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.12143