Abstract
Introduction. Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Blood transfusion can trigger an enhancement of acute inflammatory responses. Therefore, we hypothesized that perioperative blood transfusion is associated with a higher risk of POCD in aged patients following total hip replacement surgery.Material and methods. Patients older than 65 years undergoing elective total hip replacement surgery were enrolled from October 2011 to December 2012. Neurocognitive tests were evaluated at baseline and at 7 d after surgery by a Mini-Mental State Test. Multivariate logistic regression analysis was used to determine risk factors associated with POCD.Results. Fifty-six patients (27.3%) developed POCD 7 d postoperatively. Patients who developed POCD were older, had a lower education level and preoperative hemoglobin concentration, had more blood loss, and had a lower body weight (p < 0.05). Patients with POCD were more likely to receive red blood cells (RBCs) transfusion (51.8% versus 31.5%; p < 0.05). A multivariable logistic regression model identified older age, lower education level, and perioperative blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively.Conclusion. Our data suggested that perioperative blood transfusion of more than 3 units of RBCs is an independent risk factor for POCD in aged patients following total hip replacement surgery.
Highlights
Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD)
We aimed to investigate the relationship between perioperative blood transfusion and POCD in aged patients after total hip replacement surgery
There was no difference in terms of gender, American Society of Anesthesiologists (ASA) classification, fracture characteristics, episodes of hypertension and intraoperative hypotension, the amount of Ringer’s lactate infusion, length of surgery, postoperative drainage, 7 d postoperative hemoglobin concentration, fresh frozen plasma (FFP) transfusion, preoperative Mini-Mental State Examination (MMSE) scores, postoperative visual analog scale scores, tramadol consumption, or pethidine administration between the POCD and non-POCD groups (Table I)
Summary
Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Our data suggested that perioperative blood transfusion of more than 3 units of RBCs is an independent risk factor for POCD in aged patients following total hip replacement surgery. Transfusion of allogeneic blood products, including red blood cells (RBCs) and fresh frozen plasma (FFP), can trigger enhanced acute inflammatory responses [10]. In support of this notion, it has been demonstrated that blood transfusion is associated with an increase in serum tumor necrosis factor (TNF)-a, interleukin (IL)-b, IL-6, IL-8, and other cytokines [11,12].
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