Anticholinergic Exposure, Drug Dose and Postoperative Delirium: Comparison of Dose-Related and Non-Dose-Related Anticholinergic Burden Scores in a Retrospective Cohort Study of Older Orthopaedic and Trauma Surgery Patients

• DOI: 10.1007/s40266-024-01159-0
• Publication Date: 2024-11-28T13:31:59Z
• Authors: Carolin Geßele; Constanze Rémi; Vera Smolka; Konstantinos Dimi...; Ute Amann; Thomas Saller; Dorothea Strobach
• Keywords: Pharmacotherapy

Postoperative delirium (POD) is a common complication in older adult patients after surgery. A patient's preoperative anticholinergic (AC) burden potentially modifiable risk factor for POD. As the influence of drug dose remains unknown, we aimed to compare three AC scores relation POD, two which were dose-related. This retrospective cohort study (03/22–10/22) included orthopaedic and trauma surgery > 65 years. POD was assessed using four A's test (4AT), diagnosis, chart review. The determined non-dose-related German Anticholinergic Burden score (GerACB), an extension dose-related Muscarinic Acetylcholinergic Receptor ANTagonist Exposure scale (extMARANTE), Drug Index (GerDBI). Multivariable logistic regression analysis association between Scores compared kappa statistics, sensitivity, specificity, positive predictive value (PPV), negative (NPV). observed 71 385 (18.4%). For all scores, high significantly associated with adjusting age, sex, dementia, physical status, number prescribed drugs (p < 0.001). overall agreement among classifications substantial (no POD: κ = 0.645, 0.632). GerACB had lowest sensitivity 23.9% (extMARANTE: 42.3%, GerDBI: 40.8%), but highest PPV 48.6% 38.5%, 43.3%). Both have limited modest screening medication However, given additional effort required consideration, sufficient clinical practice, PPV.