Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery
IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an...
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.871229/full |
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| author | Matthias L. Herrmann Matthias L. Herrmann Cindy Boden Christoph Maurer Christoph Maurer Felix Kentischer Eva Mennig Sören Wagner Sören Wagner Lars O. Conzelmann Bernd R. Förstner Michael A. Rapp Christine A. F. von Arnim Michael Denkinger Michael Denkinger Gerhard W. Eschweiler Christine Thomas Christine Thomas |
| author_facet | Matthias L. Herrmann Matthias L. Herrmann Cindy Boden Christoph Maurer Christoph Maurer Felix Kentischer Eva Mennig Sören Wagner Sören Wagner Lars O. Conzelmann Bernd R. Förstner Michael A. Rapp Christine A. F. von Arnim Michael Denkinger Michael Denkinger Gerhard W. Eschweiler Christine Thomas Christine Thomas |
| author_sort | Matthias L. Herrmann |
| collection | DOAJ |
| description | IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people.MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD.ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55–4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15–2.02).ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients. |
| first_indexed | 2024-12-10T05:02:02Z |
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| last_indexed | 2024-12-10T05:02:02Z |
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| spelling | doaj.art-9652a520f50c42a4933c30b5f478b8ca2022-12-22T02:01:21ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-05-01910.3389/fmed.2022.871229871229Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective SurgeryMatthias L. Herrmann0Matthias L. Herrmann1Cindy Boden2Christoph Maurer3Christoph Maurer4Felix Kentischer5Eva Mennig6Sören Wagner7Sören Wagner8Lars O. Conzelmann9Bernd R. Förstner10Michael A. Rapp11Christine A. F. von Arnim12Michael Denkinger13Michael Denkinger14Gerhard W. Eschweiler15Christine Thomas16Christine Thomas17Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, GermanyGeriatric Center and Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, GermanyGeriatric Center and Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, GermanyDepartment of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, GermanyCenter for Geriatrics and Gerontology, University Medical Center Freiburg, Freiburg, GermanyCenter for Geriatrics and Gerontology, University Medical Center Freiburg, Freiburg, GermanyDepartment of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, GermanyDepartment of Anesthesiology, Klinikum Stuttgart, Stuttgart, GermanyDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United StatesHelios Clinic for Cardiac Surgery, Karlsruhe, Karlsruhe, GermanyDepartment of Social and Preventive Medicine, University of Potsdam, Potsdam, GermanyDepartment of Social and Preventive Medicine, University of Potsdam, Potsdam, GermanyDepartment of Geriatrics, University Medical Center Göttingen, Georg August University, Göttingen, Germany0Geriatric Center, Agaplesion Bethesda Clinic Ulm, Ulm, Germany1Institute for Geriatric Research, Ulm University Medical Center, Ulm, GermanyGeriatric Center and Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, GermanyGeriatric Center and Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, GermanyDepartment of Geriatric Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, GermanyIntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people.MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD.ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55–4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15–2.02).ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients.https://www.frontiersin.org/articles/10.3389/fmed.2022.871229/fulldeliriumacute encephalopathysurgeryanticholinergicgeriatricpostoperative |
| spellingShingle | Matthias L. Herrmann Matthias L. Herrmann Cindy Boden Christoph Maurer Christoph Maurer Felix Kentischer Eva Mennig Sören Wagner Sören Wagner Lars O. Conzelmann Bernd R. Förstner Michael A. Rapp Christine A. F. von Arnim Michael Denkinger Michael Denkinger Gerhard W. Eschweiler Christine Thomas Christine Thomas Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery Frontiers in Medicine delirium acute encephalopathy surgery anticholinergic geriatric postoperative |
| title | Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery |
| title_full | Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery |
| title_fullStr | Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery |
| title_full_unstemmed | Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery |
| title_short | Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery |
| title_sort | anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery |
| topic | delirium acute encephalopathy surgery anticholinergic geriatric postoperative |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.871229/full |
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