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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 and 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, Vol. 61, 109632

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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.

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