Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial

Blandfort, Sif; Gregersen, Merete; Borris, Lars C.; Damsgaard, Else Marie

doi:10.1007/s40520-016-0587-5

Cited by 29 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 surgery, we note no association with amount of units transfused and delirium development, which has been validated by a recent study by Fuchita et al 23 These findings regarding transfusion amount after esophagectomy appear to differ from those in other fields such as orthopedic surgery where liberal transfusion has been noted to be protective against delirium. 29 Our study found no association with duration of procedure consistent with most recently reported data by Fuchita et al 23 ; however, there is no consensus in this observation. 21 Although some have found an association between delirium and gender, 21,27 out study did not find a statistical difference in rates of postoperative delirium between genders.…”

Section: Discussionsupporting

confidence: 90%

“…Transfusion has been identified as an independent risk factor for delirium development after multiple types of surgical procedure including esophagectomy . More interestingly in esophageal surgery, we note no association with amount of units transfused and delirium development, which has been validated by a recent study by Fuchita et al These findings regarding transfusion amount after esophagectomy appear to differ from those in other fields such as orthopedic surgery where liberal transfusion has been noted to be protective against delirium . Our study found no association with duration of procedure consistent with most recently reported data by Fuchita et al; however, there is no consensus in this observation .…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Risk factors for delirium after esophagectomy

Dezube

Bravo‐Iñiguez

Yelamanchili

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Introduction Postoperative delirium is a common complication after major surgical procedures and affects outcomes and long‐term survival. We identified factors associated with postoperative delirium in patients undergoing esophagectomy. Methods Retrospective cohort analysis of 378 patients undergoing esophagectomy. We examined the association between postoperative delirium (DSM‐V) criteria with respect to baseline variables and postoperative complications. Results Postoperative delirium was diagnosed in 64 (16.93%) patients and associated with increasing age (P < .05), chronic obstructive pulmonary disease (P = .07), pneumonia (P = .01), transfusion intraoperatively or within 72 hours of surgery (P < .001), and sepsis (P = .001). Unplanned intubation and increased length of stay (median, 14 days) were significant in patients with delirium (P = .001 and P < .001, respectively). In a secondary analysis, surgical technique and operative approach were associated with delirium. Modified McKeown (three‐hole) esophagectomy was twice more likely to develop delirium compared with Ivor Lewis (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.03‐4.23). The strongest association was found between delirium and open techniques (thoracotomy and laparotomy) as compared with minimally invasive techniques (thoracoscopy and laparoscopy) (OR, 2.66; 95% CI, 1.22‐5.76). Survival was similar between both groups. Conclusions Postoperative delirium is common and associated with complications following esophagectomy. Identification of predisposing factors such as age and pre‐existing pulmonary diseases and proper selection of surgical treatment may reduce delirium and improve surgical outcomes.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Risk factors for delirium after esophagectomy

Dezube

Bravo‐Iñiguez

Yelamanchili

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…Blood transfusion, regarded as the quickest and most effective treatment of acute anaemia, is discussed highly controversial in terms of POD. There are indications for both, increasing [32,37] and decreasing [28,38] POD incidences.…”

Section: Discussionmentioning

confidence: 99%

Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study

et al. 2020

View full text Add to dashboard Cite

Background Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay. Methods A secondary analysis of the prospective multicentric observational CESARO-study was conducted. 800 adult patients undergoing elective surgery were enrolled from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally invasive surgery in Germany. Patients were classified as anaemic according to the World Health Organization parameters, setting the haemoglobin level cut off below 12g/dl for females and below 13g/dl for males. Focus of the investigation were patients with acute anaemia. Patients with present preoperative anaemia or missing haemoglobin measurement were excluded from the sample set. Delirium screening was established postoperatively for at least 24 hours and up to three days, applying the validated Nursing Delirium Screening Scale.

show abstract

“…In addition, increased risk of postoperative infections including pneumonia, delirium, short-term mortality, length of hospital stay and systemic inflammatory response syndrome in patients receiving blood transfusion(s) was reported [ 4 , 13 – 17 ]. In contrast, other studies suggest that EBT improves short-term functional outcomes [ 18 – 21 ] and prevents delirium in frail elderly [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 95%

Effect of blood transfusion on survival after hip fracture surgery

Smeets

Verbruggen

Poeze

2018

Eur J Orthop Surg Traumatol

View full text Add to dashboard Cite

BackgroundOur primary goal was to audit the incidence of erythrocyte blood transfusion (EBT) after hip fracture surgery and study the effects on perioperative complications and early and late mortality. MethodsIn a retrospective cohort study all patients 65 years old and above treated operatively for an acute hip fracture were included over a 48-month period with a 2-year follow-up period. Postoperative hemoglobin levels were used to investigate at what threshold EBT was used. The relation between EBT and perioperative complications and survival was analyzed with multivariate regression analysis. A propensity score for predicting the chance of receiving an EBT was calculated and used to differentiate between transfusion being a risk factor for mortality and other related confounding risk factors. Mortality was subdivided as in-hospital, 30-day, 1-year and 2-year mortality.ResultsOf the 388 included patients, 41% received a blood transfusion. The postoperative hemoglobin level was the strongest predictor for EBT. Patients who received EBT had a significant longer hospital stay and more postoperative cardiac complications, even after adjustment for confounders. Multivariate analysis for mortality showed that EBT was a significant risk factor for early as well as late mortality, but after adding the propensity score, EBT was no longer associated with increased mortality.ConclusionThere was no effect of EBT on mortality after correction with propensity scoring for predictors of EBT. Transfusion in patients treated operatively for hip fracture should be evenly matched with their cardiovascular risk during the perioperative phase.

show abstract

Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial

Abstract: In nursing home residents undergoing surgery for hip fracture, maintaining hemoglobin level above 11.3 g/dL reduces the rate of POD on day 10 compared to a RB. Development of POD is associated with increased mortality.

Cited by 29 publications

References 24 publications

Risk factors for delirium after esophagectomy

Risk factors for delirium after esophagectomy

Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study

Effect of blood transfusion on survival after hip fracture surgery

Contact Info

Product

Resources

About