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Purpose <p>Polypharmacy is a&#xa0;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.</p> Methods <p>Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a&#xa0;prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.</p> Results <p>The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2&#xa0;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&#xa0;significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43&#xa0;patients (10.4%). The delirium rate was 25.6% (<i>n</i> = 11) and 11.0% (<i>n</i> = 40) had no anticholinergic burden. A&#xa0;significant correlation can be demonstrated with χ<sup>2</sup>(1) = 7.52, <i>p</i> = 0.006, Cramer’s V = 0.136. There was a&#xa0;2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31–5.97).</p> Conclusion <p>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&#xa0;simple and reliable screening tool and should be part of a&#xa0;preoperative geriatric assessment.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月6日

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

摘要

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.