Anticholinergic burden of long-term medication is an independent risk factor for the development of postoperative delirium: A clinical trial

Müller, Anika; Spies, Claudia D.; Eckardt, Rahel; Weiss, Björn; Pohrt, Anne; Wernecke, Klaus-Dieter; Schmidt, Maren; Dossow, Vera von; Scholtz, Kathrin; Weiss-Gerlach, Edith; Al-Hashem, Anwar; Braun, Susanne; Brinkmann, Frederik; Collette, Anna-Maria; Degel, Franziska; de Beukelaer, Frederic; Geue, Susanne; Hartmann, Kerstin; Hennig, Saskia; Hoffmann, Inga; Mohr, Oskar und Petrov, Georgi (2020): Anticholinergic burden of long-term medication is an independent risk factor for the development of postoperative delirium: A clinical trial. In: Journal of Clinical Anesthesia, Bd. 61, 109632

Abstract

Background: Postoperative delirium (POD) is a common complication after surgery. Objective: We sought to determine the association between preoperative anticholinergic load calculated using the anticholinergic drug scale (ADS) and POD in cancer patients over 65 years of age. Design: A retrospective sub-investigation of a randomised controlled interventional trial. Setting: Two tertiary university hospitals. Patients: Overall, patients aged 65 years and older scheduled for surgical treatment of gasffointestinary, genitourinary or gynaecological cancers. Main outcome measures: The primary outcome was the interaction between anticholinergic drug scale and occurrence of postoperative delirium. Patient clinical parameters and ADS scores were assessed preoperatively. POD screening was conducted for a total of 7 days following surgery using validated measures. Independent associations between ADS and POD were assessed using multivariate logistical regression analyses. Results: A total of 651 patients (mean age, 71.8 years;68.5% males) were included. Of those, 66 patients (10.1%) developed POD. The ADS score was independently associated with the occurrence of POD (higher ADS per point OR 1.496;95% CI 1.09-2.05;p = 0.01). Additionally, age (per year OR 1.06;CI 95% CI 1.01-1.11;p = 0.03) and ASA state (OR 2.16;95% CI 1.22-3.83;p = 0.01), as well as stay on ICU (yes vs. no OR 2.8;95% CI 1.57-4.998;p < 0.01), were independently associated with POD. Conclusions: ADS assessment according to chronic medication use is a cost-effective, non-invasive method of identifying elderly cancer patients at risk for POD.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0952-8180
• Sprache: Englisch