The Relationship between Perioperative Blood Transfusion and Postoperative Delirium in Patients Undergoing Spinal Fusion Surgery: Clinical Data Warehouse Analysis

Abstract

Background and Objectives: For preventing postoperative delirium (POD), identifying the risk factors is important. However, the relationship between blood transfusion and POD is still controversial. The aim of this study was to identify the risk factors of POD, to evaluate the impact of blood transfusion in developing POD among people undergoing spinal fusion surgery, and to show the effectiveness of big data analytics using a clinical data warehouse (CDW). Materials and Methods: The medical data of patients who underwent spinal fusion surgery were obtained from the CDW of the five hospitals of Hallym University Medical Center. Clinical features, laboratory findings, perioperative variables, and medication history were compared between patients without POD and with POD. Results: 234 of 3967 patients (5.9%) developed POD. In multivariate logistic regression analysis, the risk factors of POD were as follows: Parkinson’s disease (OR 5.54, 95% CI 2.15–14.27; p < 0.001), intensive care unit (OR 3.45 95% CI 2.42–4.91; p < 0.001), anti-psychotics drug (OR 3.35 95% CI 1.91–5.89; p < 0.001), old age (≥70 years) (OR 3.08, 95% CI 2.14–4.43; p < 0.001), depression (OR 2.8 95% CI 1.27–6.2; p < 0.001). The intraoperative transfusion (OR 1.1, 95% CI 0.91–1.34; p = 0.582), and the postoperative transfusion (OR 0.91, 95% CI 0.74–1.12; p = 0.379) had no statistically significant effect on the incidence of POD. Conclusions: There was no relationship between perioperative blood transfusion and the incidence of POD in spinal fusion surgery. Big data analytics using a CDW could be helpful for the comprehensive understanding of the risk factors of POD, and for preventing POD in spinal fusion surgery.

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants

“…Thirty-seven studies were excluded because they examined non-population-based cohorts, they were meta-analyses, they were reviews, or they did not report outcome data. Finally, 50 studies [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] ] were included in this meta-analysis ( Fig. 1 and eTable 3 in the Supplement).…”

“…The baseline characteristics of the included studies are shown in Table 1 . All the included studies were published from 2006 to 2021, with 76 % of them [ 2 , 4 , 6 , 7 , [10] , [11] , [12] , [14] , [15] , [16] , [17] , 19 , [25] , [26] , [32] , [35] , [36] , [44] , 34 , 37 , 27 , [23] , [24] , [28] , [29] , [30] , [31] , [33] , [38] , [40] , [41] , [42] , [45] , [46] , [47] , [48] , 39 , 43 ] published in 2015 or later. Twenty studies [ 2 , 7 , 8 , 15 , 16 , [25] , [32] , [44] , [27] , [34] , [37] , [50] , [52] , [30] , [31] , [33] , [40] , 42 , 24 , 43 ] were conducted in the United States, twenty-six [ 3 , 4 , 6 , [9] , [10] , [11] ,…”

“…Three or more points indicate a delirium Gao, R. [ 13 ] 2008 Retrospective analysis China 2007.05–2007.11 549 44.99 Diagnosis of this delirious state is usually done according to the CAM criteria, the TICS, MMS, SAS, DRS or NCS Kawaguchi, Y. [ 54 ] 2006 Retrospective analysis Japan 2000–2002 104 45.45 The presence of delirium was diagnosed by the CAM First author Delirium definition Significant factors Incidence, n (%) Adjusted variables Kwon, Y. S. [ 23 ] A mental disorder characterized by acute and fluctuating course of consciousness disturbance Old age (≥70 years), Parkinson's disease, depression, Intensive care unit stay, anti-psychotics drug 5.90 NR Gold, C. [ 24 ] An abrupt disturbance of cognition and consciousness and is characterized by a decreased ability to sustain or shift attention, impairment of memory and executive function, and fluctuation in arousal levels Age, Lower preoperative, Postoperative hemoglobin, Higher ASA grade, Greater extent of surgery, Higher postoperative pain scores 24.60 A binomial logistic regression model was designed using a custom written MATLAB script Wang, D. D. [ 4 ] An acute condition characterized by reduced awareness of the environment and a disturbance in attention Restrictive fluid therapy, GDT 8.20 Age, ASA classification, BMI, or postoperative pain are no statistically significant differences which ensures the comparability of the two groups Arizumi, F. [ 6 ] A common and serious complication after surgery Patient factors, Surgical factors, Comorbid disease, System disorder 22.00 ...…”

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair

“…The present study demonstrated the risk of postoperative blood transfusion for delirium. The possible reason is that anemia or blood loss is highly correlated with transfusion, which may cause reduced cerebral blood flow and impair tissue oxygenation capacity, thereby causing delirium ( 34 , 35 ). In addition, blood transfusion itself may cause POD since it may result in dysregulation of cytokines and further amplify the systemic inflammatory response ( 34 ).…”

“…The possible reason is that anemia or blood loss is highly correlated with transfusion, which may cause reduced cerebral blood flow and impair tissue oxygenation capacity, thereby causing delirium ( 34 , 35 ). In addition, blood transfusion itself may cause POD since it may result in dysregulation of cytokines and further amplify the systemic inflammatory response ( 34 ). Further studies are needed to confirm the role of blood transfusion in the development of POD.…”