title: Impact of length of red blood cells transfusion on postoperative delirium in elderly patients undergoing hip fracture surgery: A cohort study.
abstract: OBJECTIVE
  The purpose of the present study was to test whether older red blood cells (RBCs) transfusion results in an increased risk of postoperative delirium (POD) and various in-hospital postoperative complications in elderly patients undergoing hip fracture surgery.
  
  
  METHODS
  Patients (≥65 years) who underwent hip fracture surgery were enrolled, 179 patients were divided into two groups according to the storage time of the RBCs. The shorter storage time of RBCs transfusion group comprised patients who received RBCs ≤14 days old and the longer storage time of RBCs transfusion group comprised patients who received RBCs >14 days old. The blood samples were collected before anaesthesia induction, 4 and 24 h after RBCs transfusion for the determination of proinflammatory mediators, malondialdehyde, and superoxide dismutase activity.
  
  
  RESULTS
  There was no difference in the baseline characteristics, the incidence of POD, and the in-hospital postoperative complications between the shorter storage time of RBCs transfusion group and the longer storage time of RBCs transfusion groups (P>0.05). Compared with the shorter storage time of RBCs transfusion group, the longer storage time of RBCs transfusion caused significantly longer duration of POD (P<0.05). There were significantly increased plasma levels of IL-8 and malondialdehyde at 24 h and IL-1β at 4 h after RBCs transfusion in the POD group compared with the non-POD group (P<0.05).
  
  
  CONCLUSIONS
  Transfusion of the longer storage RBCs is not associated with a higher incidence of POD or in-hospital postoperative complications, but with longer duration of POD in elderly patients undergoing hip fracture surgery.
authors.affiliation: Department of Anesthesiology, People's Hospital of Lishui County, Nanjing 211200, China.
authors.forename: Zhuang-Yun
authors.initials: ZY
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
authors.forename: Da-Peng
authors.initials: DP
authors.lastname: Gao
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China; Jiangsu Province Key Laboratory of Anaesthesiology, Xuzhou Medical College, Xuzhou, China; Jiangsu Province Key Laboratory of Anaesthesia and Analgesia Application Technology, Xuzhou, China.
authors.forename: Jiao-Jiao
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
authors.forename: Xiao-ru
authors.initials: XR
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, People's Hospital of Lishui County, Nanjing 211200, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Fang
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China; Jiangsu Province Key Laboratory of Anaesthesiology, Xuzhou Medical College, Xuzhou, China; Jiangsu Province Key Laboratory of Anaesthesia and Analgesia Application Technology, Xuzhou, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China. Electronic address: jimuhuo2009@sina.com.
authors.forename: Mu-Huo
authors.initials: MH
authors.lastname: Ji
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D003693:Delirium / Q000097:blood / Q000209:etiology; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000097:blood*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood / Q000523:psychology*; D011446:Prospective Studies; D013482:Superoxide Dismutase / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D008315:Malondialdehyde; D013482:Superoxide Dismutase
keywords: Elderly; Hip fracture; Length of red blood cells; Postoperative delirium; RBCs transfusion