Key result
Red blood cell transfusion linked to ~288% greater postoperative delirium risk, rising with units transfused.
Why the study?
Red blood cell transfusion is frequently needed during hip fracture surgery but has been inconsistently associated with incident post-operative delirium in previous studies.
Does perioperative red blood cell transfusion increase the risk of post-operative delirium in elderly patients undergoing hip fracture surgery?
Observational (n=364)
Does perioperative red blood cell transfusion increase the risk of post-operative delirium in elderly patients undergoing hip fracture surgery?
Perioperative red blood cell transfusion during hip fracture surgery in elderly patients is associated with a nearly four-fold increased risk of post-operative delirium, with a significant dose-response relationship.
May warrant caution with RBC transfusion in elderly hip fracture patients; leaves open causality pending randomized trials.
PURPOSE: Delirium is common following hip fracture surgery. Red blood cell transfusion (RBCT), which is frequently needed in this population, has been inconsistently associated with incident delirium in previous studies. This study aims to investigate whether RBCT in patients undergoing hip fracture surgery is associated with increased risk of post-operative delirium, and to identify potential risk factors that might influence this association. MATERIALS AND METHODS: We conducted a retrospective observational study of all hip fracture patients who underwent surgery between November 1 2020 and February 28 2022. Delirium was diagnosed based on DSM V criteria, and assessed daily. The need of perioperative RBCT, and the number of units transfused, were recorded. RESULTS: A total of 364 participants with a mean age of 84 years were included. Delirium was recorded in 49 (14%) patients, while 88 (24%) required RBCT. In logistic regression, RBCT was associated with delirium (OR = 3.88, 95% CI = 1.23-12.24), after adjusting. An increasing number of RB units transfused was associated with increased probability of delirium (P for linear trend = .013). CONCLUSIONS: Clinicians should carefully consider the indications for RBCT in hip fracture patients. Further studies are needed to confirm these results, and to investigate the potential mechanisms underlying this association.
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Laudisio et al. (2026) conducted an observational in hip fracture (n=364). Red blood cell transfusion vs. No red blood cell transfusion was evaluated on post-operative delirium (OR 3.88, 95% CI 1.23-12.24). Perioperative red blood cell transfusion was associated with an increased risk of post-operative delirium in patients undergoing hip fracture surgery (OR 3.88; 95% CI 1.23-12.24).
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