Anticholinergic Drug Exposure Increases the Risk of Delirium in Older Patients Undergoing Elective Surgery

Frontiers in Medicine

article

Matthias L. Herrmann¹  Cindy Boden²  Christoph Maurer¹  Felix Kentischer³  Eva Mennig⁴  Sören Wagner⁵  Lars O. Conzelmann⁷  Bernd R. Förstner⁸  Michael A. Rapp⁸  Christine A. F. von Arnim⁹  Michael Denkinger^1,10  Gerhard W. Eschweiler²  Christine Thomas² 

[1] Department of Neurology and Neurophysiology, Medical Center-University of Freiburg;Geriatric Center and Department of Psychiatry and Psychotherapy, Tübingen University Hospital;Center for Geriatrics and Gerontology, University Medical Center Freiburg;Department of Geriatric Psychiatry and Psychotherapy;Department of Anesthesiology;Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School;Helios Clinic for Cardiac Surgery;Department of Social and Preventive Medicine, University of Potsdam;Department of Geriatrics, University Medical Center Göttingen, Georg August University;Geriatric Center, Agaplesion Bethesda Clinic Ulm;Institute for Geriatric Research, Ulm University Medical Center

关键词: delirium;    acute encephalopathy;    surgery;    anticholinergic;    geriatric;    postoperative;   

DOI  :  10.3389/fmed.2022.871229

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction Postoperative 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. Methods Between 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. Results POD 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). Conclusion Preoperative 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.

【 授权许可】

CC BY