Polypharmacy and anticholinergic burden as risk factors for postoperative delirium in surgical medicine.

IF 1.1 4区医学 Q4 GERIATRICS & GERONTOLOGY Zeitschrift Fur Gerontologie Und Geriatrie Pub Date : 2025-01-06 DOI:10.1007/s00391-024-02388-z

Henriette Louise Moellmann, Soufian Boulghoudan, Julian Kuhlmann, Louisa Rahm, Helmut Frohnhofen

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Abstract

Purpose: Polypharmacy is a widespread phenomenon in older patients. In particular, the anticholinergic burden of medication is an important risk factor for delirium due to age-related changes in the cholinergic system.

Methods: Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.

Results: The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2 years, respectively. Antidepressants odds ratio (OR) 3.16 (95% confidence interval. CI, 1.51-6.64), antidiabetic drugs OR 2.53 (95% CI 1.27-5.03), neuroleptics OR 3.52 (95% CI 1.70-7.28) and Parkinson medication OR 5.88 (95% CI 1.95-17.7) showed a significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43 patients (10.4%). The delirium rate was 25.6% (n = 11) and 11.0% (n = 40) had no anticholinergic burden. A significant correlation can be demonstrated with χ²(1) = 7.52, p = 0.006, Cramer's V = 0.136. There was a 2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31-5.97).

Conclusion: The standardized recording of medication is essential, especially when identifying patients at risk of suffering from delirium. The use of the ACB score to assess the anticholinergic burden is a simple and reliable screening tool and should be part of a preoperative geriatric assessment.

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多种药物和抗胆碱能负荷是外科医学中术后谵妄的危险因素。

目的：多药是老年患者普遍存在的现象。特别是，抗胆碱能药物负担是一个重要的危险因素谵妄，由于胆碱能系统的年龄相关的变化。方法：在一项前瞻性研究（421例患者）中记录术前用药，包括计算抗胆碱能负荷（ACB），以确定与药物摄入相关的潜在风险。术后每日进行谵妄筛查。结果：女性199例（47.3%），男性222例（52.7%），年龄分别为80.8 ±6.7岁和78.8 ±6.2岁。抗抑郁药优势比（OR） 3.16（95%可信区间）。CI, 1.51-6.64)，降糖药OR 2.53 (95% CI 1.27-5.03)，抗精神病药OR 3.52 （95% CI 1.70-7.28）和帕金森药物OR 5.88 （95% CI 1.95-17.7）显示谵妄的风险显著增加。ACB评分显示43例（10.4%）患者存在抗胆碱能负荷。谵妄率为25.6% (n = 11),11.0% （n = 40）无抗胆碱能负荷。χ2(1) = 7.52,p = 0.006,Cramer’s V = 0.136。谵妄的风险高出2.79倍（OR 2.79, 95% CI 1.31-5.97）。结论：规范用药记录是必要的，特别是在识别有谵妄风险的患者时。使用ACB评分评估抗胆碱能负荷是一种简单可靠的筛查工具，应作为术前老年评估的一部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Zeitschrift Fur Gerontologie Und Geriatrie 医学-老年医学

CiteScore

2.00

自引率

16.70%

发文量

126

审稿时长

6-12 weeks

期刊介绍： The fact that more and more people are becoming older and are having a significant influence on our society is due to intensive geriatric research and geriatric medicine in the past and present. The Zeitschrift für Gerontologie und Geriatrie has contributed to this area for many years by informing a broad spectrum of interested readers about various developments in gerontology research. Special issues focus on all questions concerning gerontology, biology and basic research of aging, geriatric research, psychology and sociology as well as practical aspects of geriatric care. Target group: Geriatricians, social gerontologists, geriatric psychologists, geriatric psychiatrists, nurses/caregivers, nurse researchers, biogerontologists in geriatric wards/clinics, gerontological institutes, and institutions of teaching and further or continuing education.