Anika Mueller1, Claudia D Spies2, Rahel Eckardt3, Bjoern Weiss1, Anne Pohrt4, Klaus-Dieter Wernecke5, Maren Schmidt6. 1. Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany. 2. Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany. Electronic address: claudia.spies@charite.de. 3. Charité Research Group on Geriatrics, Charité - Universitätsmedizin Berlin, Germany. 4. Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany. 5. Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Berlin, Germany. 6. Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany; Department of Anesthesiology and Intensive Care Medicine, Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Eberswalde, Germany.
Abstract
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 gastrointestinary, 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. TRIAL REGISTRY: www.clinicaltrials.gov. Identifier NCT01278537. Ethics: IRB of Charité University-Medicine Berlin, Germany; EA2/241/08.
RCT Entities:
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 cancerpatients 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 gastrointestinary, 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 cancerpatients at risk for POD. TRIAL REGISTRY: www.clinicaltrials.gov. Identifier NCT01278537. Ethics: IRB of Charité University-Medicine Berlin, Germany; EA2/241/08.
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