Hierarchical decision-making mechanism of perioperative restricted red blood cell infusion based on cerebral regional oxygen saturation

Abstract Background/Objective： We aimed to establish a hierarchical decision-making mechanism for perioperative restricted red blood cell transfusion based on cerebral regional oxygen saturation (rSO2), and evaluate its role in blood transfusion management in elderly patients undergoing total knee replacement (THR) or total hip replacement (TKA). Methods: Eighty elderly patients with perioperative hemoglobin (Hb) in the range of 70 g/L to 100 g/L were divided into study group (improved restrictive transfusion group) and control group ("peri-operative transfusion trigger score (POTTS)" group) by random number table method. The person number of blood transfusion, the average volume of red blood cells transfused, rSO2 and Hb levels of all patients, and the number of patients with postoperative delirium (POD) were recorded. Results: The person number of blood transfusion and the average volume of red blood cells transfused in the study group were higher than those in the control group (P<0.05). From the first day to the seventh day after surgery, the Hb level in the study group was significantly higher than that in the control group (P<0.05). On the second and third day after surgery, rSO2 in the study group was significantly higher than that in the control group, and POD incidence was lower than that in the control group (P<0.05). Correlation analysis of rSO2 and Hb levels in all patients throughout the whole process r=0.923, higher rSO2 on the second and third day after surgery was the protective factor of POD (P<0.05). Conclusion: The decision-making mechanism of improved restrictive transfusion consumes more blood resources, but it also significantly increases the levels of rSO2 and Hb in elderly patients and reduces the incidence of POD.