Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study

BioCog Consortium

doi:10.1007/s40266-021-00839-5

Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study

BioCog Consortium

Clinical sciences

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.

OBJECTIVES: The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.

METHODS: This investigation was part of the European BioCog project ( http://www.biocog.eu ), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.

RESULTS: In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296).

CONCLUSION: This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.

Original language	English
Pages (from-to)	347-354
Number of pages	8
Journal	Drugs & Aging
Volume	38
Issue number	4
DOIs	https://doi.org/10.1007/s40266-021-00839-5
Publication status	Published - Apr 2021

Bibliographical note

Funding Information:
Maria Heinrich is a participant in the Charité Digital Clinician Scientist Program funded by Deutsche Forschungsgemeinschaft. Maria Heinrich, Anika Müller, Andela Cvijan, Rudolf Mörgeli, Jochen Kruppa, Georg Winterer, Arjen J. C. Slooter and Claudia D. Spies have no conflicts of interest that are directly relevant to the content of this article.

Funding Information:
The authors thank Konstanze Scheurer (Charité-Universitätsmedizin Berlin) for administrative support with study coordination and management. Kathrin Scholtz supported the study as the clinical monitor. Henning Krampe supported the study by recruiting and supervising students for neuropsychological testing. Data management was provided by Olaf Bender and Alexander Krannich at Koordininierungszentrum für Klinische Studien (KKS Berlin) supported by PharmaImage Biomarkers Solutions GmbH. We thank our team of investigators, medical doctoral students and study nurses: Alissa Wolf, Fatima Yürek, Daniel Hadzidiakos, Friedrich Borchers, Ilse Kant, Simone van Montfort, Gunnar Lachmann, Anika Alon, Sina Rosenblender, Tuba Aslan, Markus Laubach, Felix Müller, Emmanuel Keller, Eleftheria Papadaki, Saya Speidel, Bennet Borak, Steffi Herferth, Johannes Lange, Mario Lamping, Helene Michler, Juliane Dörfler, Anton Jacobshagen, Petra Kozma, Marinus Fislage, Wolf Rüdiger Brockhaus, Luisa Rothe, Pola Neuling, Ken-Dieter Michel, Zdravka Bosancic, Firas Nosirat, Maryam Kurpanik, Sophia Kuenz, Lukas Roediger, Irene Mergele, Anja Nottbrock, Florian Lammers-Litz, Leopold Rupp, Marie Graunke and Victoria Windmann. The authors further wish to thank the team of students and interns of the Department of Anesthesiology at the Charité-Universitätsmedizin Berlin.

Funding Information:
Open Access funding enabled and organized by Projekt DEAL. This work was conducted with support of the European Union Seventh Framework Programme [FP7/2007-2013] as part of the BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), under Grant no. 602461.

Publisher Copyright:
© 2021, The Author(s).

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

Aged
Cholinergic Antagonists/adverse effects
Cognitive Dysfunction
Delirium/chemically induced
Humans
Postoperative Complications/chemically induced
Prospective Studies

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10.1007/s40266-021-00839-5

Cite this

@article{84eb995c22324dbab29fdd9e392165dd,

title = "Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study",

abstract = "BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.OBJECTIVES: The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.METHODS: This investigation was part of the European BioCog project ( http://www.biocog.eu ), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.RESULTS: In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296).CONCLUSION: This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.",

keywords = "Aged, Cholinergic Antagonists/adverse effects, Cognitive Dysfunction, Delirium/chemically induced, Humans, Postoperative Complications/chemically induced, Prospective Studies",

author = "{BioCog Consortium} and Maria Heinrich and Anika M{\"u}ller and Andela Cvijan and Rudolf M{\"o}rgeli and Jochen Kruppa and Georg Winterer and Slooter, {Arjen J C} and Spies, {Claudia D}",

note = "Funding Information: Maria Heinrich is a participant in the Charit{\'e} Digital Clinician Scientist Program funded by Deutsche Forschungsgemeinschaft. Maria Heinrich, Anika M{\"u}ller, Andela Cvijan, Rudolf M{\"o}rgeli, Jochen Kruppa, Georg Winterer, Arjen J. C. Slooter and Claudia D. Spies have no conflicts of interest that are directly relevant to the content of this article. Funding Information: The authors thank Konstanze Scheurer (Charit{\'e}-Universit{\"a}tsmedizin Berlin) for administrative support with study coordination and management. Kathrin Scholtz supported the study as the clinical monitor. Henning Krampe supported the study by recruiting and supervising students for neuropsychological testing. Data management was provided by Olaf Bender and Alexander Krannich at Koordininierungszentrum f{\"u}r Klinische Studien (KKS Berlin) supported by PharmaImage Biomarkers Solutions GmbH. We thank our team of investigators, medical doctoral students and study nurses: Alissa Wolf, Fatima Y{\"u}rek, Daniel Hadzidiakos, Friedrich Borchers, Ilse Kant, Simone van Montfort, Gunnar Lachmann, Anika Alon, Sina Rosenblender, Tuba Aslan, Markus Laubach, Felix M{\"u}ller, Emmanuel Keller, Eleftheria Papadaki, Saya Speidel, Bennet Borak, Steffi Herferth, Johannes Lange, Mario Lamping, Helene Michler, Juliane D{\"o}rfler, Anton Jacobshagen, Petra Kozma, Marinus Fislage, Wolf R{\"u}diger Brockhaus, Luisa Rothe, Pola Neuling, Ken-Dieter Michel, Zdravka Bosancic, Firas Nosirat, Maryam Kurpanik, Sophia Kuenz, Lukas Roediger, Irene Mergele, Anja Nottbrock, Florian Lammers-Litz, Leopold Rupp, Marie Graunke and Victoria Windmann. The authors further wish to thank the team of students and interns of the Department of Anesthesiology at the Charit{\'e}-Universit{\"a}tsmedizin Berlin. Funding Information: Open Access funding enabled and organized by Projekt DEAL. This work was conducted with support of the European Union Seventh Framework Programme [FP7/2007-2013] as part of the BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), under Grant no. 602461. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = apr,

doi = "10.1007/s40266-021-00839-5",

language = "English",

volume = "38",

pages = "347--354",

journal = "Drugs & Aging",

issn = "1170-229X",

publisher = "Adis International Ltd",

number = "4",

}

TY - JOUR

T1 - Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium

T2 - A Prospective Observational Study

AU - BioCog Consortium

AU - Heinrich, Maria

AU - Müller, Anika

AU - Cvijan, Andela

AU - Mörgeli, Rudolf

AU - Kruppa, Jochen

AU - Winterer, Georg

AU - Slooter, Arjen J C

AU - Spies, Claudia D

N1 - Funding Information: Maria Heinrich is a participant in the Charité Digital Clinician Scientist Program funded by Deutsche Forschungsgemeinschaft. Maria Heinrich, Anika Müller, Andela Cvijan, Rudolf Mörgeli, Jochen Kruppa, Georg Winterer, Arjen J. C. Slooter and Claudia D. Spies have no conflicts of interest that are directly relevant to the content of this article. Funding Information: The authors thank Konstanze Scheurer (Charité-Universitätsmedizin Berlin) for administrative support with study coordination and management. Kathrin Scholtz supported the study as the clinical monitor. Henning Krampe supported the study by recruiting and supervising students for neuropsychological testing. Data management was provided by Olaf Bender and Alexander Krannich at Koordininierungszentrum für Klinische Studien (KKS Berlin) supported by PharmaImage Biomarkers Solutions GmbH. We thank our team of investigators, medical doctoral students and study nurses: Alissa Wolf, Fatima Yürek, Daniel Hadzidiakos, Friedrich Borchers, Ilse Kant, Simone van Montfort, Gunnar Lachmann, Anika Alon, Sina Rosenblender, Tuba Aslan, Markus Laubach, Felix Müller, Emmanuel Keller, Eleftheria Papadaki, Saya Speidel, Bennet Borak, Steffi Herferth, Johannes Lange, Mario Lamping, Helene Michler, Juliane Dörfler, Anton Jacobshagen, Petra Kozma, Marinus Fislage, Wolf Rüdiger Brockhaus, Luisa Rothe, Pola Neuling, Ken-Dieter Michel, Zdravka Bosancic, Firas Nosirat, Maryam Kurpanik, Sophia Kuenz, Lukas Roediger, Irene Mergele, Anja Nottbrock, Florian Lammers-Litz, Leopold Rupp, Marie Graunke and Victoria Windmann. The authors further wish to thank the team of students and interns of the Department of Anesthesiology at the Charité-Universitätsmedizin Berlin. Funding Information: Open Access funding enabled and organized by Projekt DEAL. This work was conducted with support of the European Union Seventh Framework Programme [FP7/2007-2013] as part of the BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), under Grant no. 602461. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.OBJECTIVES: The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.METHODS: This investigation was part of the European BioCog project ( http://www.biocog.eu ), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.RESULTS: In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296).CONCLUSION: This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.

AB - BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.OBJECTIVES: The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.METHODS: This investigation was part of the European BioCog project ( http://www.biocog.eu ), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini-Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.RESULTS: In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749-1.150; ARS [points] OR 0.832; 95% CI 0.564-1.227; ACBS [points] OR 1.045; 95% CI 0.842-1.296).CONCLUSION: This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.

KW - Aged

KW - Cholinergic Antagonists/adverse effects

KW - Cognitive Dysfunction

KW - Delirium/chemically induced

KW - Humans

KW - Postoperative Complications/chemically induced

KW - Prospective Studies

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U2 - 10.1007/s40266-021-00839-5

DO - 10.1007/s40266-021-00839-5

M3 - Article

C2 - 33721289

VL - 38

SP - 347

EP - 354

JO - Drugs & Aging

JF - Drugs & Aging

SN - 1170-229X

IS - 4

ER -

Preoperative Comparison of Three Anticholinergic Drug Scales in Older Adult Patients and Development of Postoperative Delirium: A Prospective Observational Study

Abstract

Bibliographical note

Keywords

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