The Effects of Blood Transfusion on Delirium Incidence

Zanden, Vera van der; Beishuizen, Sara J.; Scholtens, Rikie M.; Jonghe, Annemarieke de; Rooij, Sophia E. de; Munster, Barbara C. Van

doi:10.1016/j.jamda.2016.04.008

Cited by 46 publications

(33 citation statements)

References 42 publications

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“…Patients with a history of the other neuropsychiatric disorders such as drug abuse (OR = 1.90), psychosis (OR = 2.18), alcohol abuse (OR = 2.79) and depression (OR = 1.43) were at increased risk of postoperative delirium[1,4]. A diagnoses of either chronic deficiency (e.g., iron, Vitamin B12) anemia (OR = 1.36) or chronic blood loss anemia (OR = 1.54) were independent risk factors, confirming previous findings that patients with perioperative anemia were more likely to experience delirium[4,16,23,[32][33][34]. Other comorbidities such as fluid and electrolyte disorders (OR = 2.41), congestive heart failure (OR = 1.59), coagulopathy (OR = 1.53), renal failure(OR = 1.36), peripheral vascular disorders (OR = 1.29), uncomplicated diabetes (OR = 1.20) and diabetes with chronic complications (OR = 1.87) had also been previously reported as risk factors of delirium[4,14,22,23].…”

supporting

confidence: 77%

Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Wang

Yang

et al. 2020

Preprint

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BackgroundPostoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after total knee arthroplasty (TKA) has not been well studied using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of insurance, in-hospital mortality, and medical and surgical perioperative complications were evaluated.ResultsA total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008. Patients with delirium after TKA presented more comorbidities, increased LOS, extra hospital charges, wider coverage of medicare, and higher in-hospital mortality (P<0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease and pulmonary circulation disorders, peripheral vascular disorders, renal failure, and teaching hospital. ConclusionsA relatively low incidence of delirium after TKA was identified. Postoperative delirium of TKA was associated with increased comorbidities, LOS, total charges, coverage of medicare, mortality and medical perioperative complications. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.

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supporting

confidence: 77%

Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Wang

Yang

et al. 2020

Preprint

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“…Due to the heterogenous definition of anaemia it proofs to be challenging to compare earlier studies with the current one, which investigated postoperative anaemia and POD. An association between postoperative anaemia with a HB level equal to and below 9.7 g/dl [28] or postoperative haematocrit � 30% [29], [30,31] and POD has already been established.…”

Section: Discussionmentioning

confidence: 94%

“…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

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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.

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“…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

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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.

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The Effects of Blood Transfusion on Delirium Incidence

Cited by 46 publications

References 42 publications

Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

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

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