title: Association between intraoperative blood transfusions and early postoperative delirium in older adults.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Secondary analysis using a database created for a prospective cognitive outcomes study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Four hundred seventy-two individuals aged 65 and older undergoing major noncardiac surgery.
  
  
  METHODS
  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 < .001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA 94143, USA. behrendsm@anesthesia.ucsf.edu
authors.forename: Matthias
authors.initials: M
authors.lastname: Behrends
authors.forename: Glen
authors.initials: G
authors.lastname: DePalma
authors.forename: Laura
authors.initials: L
authors.lastname: Sands
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Leung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D065227:Transfusion Reaction