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.