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.

IF 3.4 3区医学 Q2 GERIATRICS & GERONTOLOGY

Drugs & Aging Pub Date : 2024-12-01 Epub Date: 2024-11-28 DOI:10.1007/s40266-024-01159-0

Carolin Geßele, Constanze Rémi, Vera Smolka, Konstantinos Dimitriadis, Ute Amann, Thomas Saller, Dorothea Strobach

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引用次数: 0

Abstract

Purpose: Postoperative delirium (POD) is a common complication in older adult patients after surgery. A patient's preoperative anticholinergic (AC) burden is a potentially modifiable risk factor for POD. As the influence of the drug dose remains unknown, we aimed to compare three AC burden scores in relation to POD, two of which were dose-related.

Methods: This retrospective cohort study (03/22-10/22) included orthopaedic and trauma surgery patients > 65 years. POD was assessed using the four A's test (4AT), delirium diagnosis, and chart review. The AC burden was determined using the non-dose-related German Anticholinergic Burden score (GerACB), an extension of the dose-related Muscarinic Acetylcholinergic Receptor ANTagonist Exposure scale (extMARANTE), and the dose-related German Drug Burden Index (GerDBI). Multivariable logistic regression analysis determined the association between the preoperative AC burden and POD. Scores were compared using kappa statistics, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: POD was observed in 71 of 385 patients (18.4%). For all three scores, a high AC burden was significantly associated with POD after adjusting for age, sex, dementia, preoperative physical status, and number of prescribed drugs (p < 0.001). The overall agreement among the burden classifications was substantial (no POD: κ = 0.645, POD: κ = 0.632). The GerACB had the lowest sensitivity with 23.9% (extMARANTE: 42.3%, GerDBI: 40.8%), but the highest PPV with 48.6% (extMARANTE: 38.5%, GerDBI: 43.3%).

Conclusion: Both dose-related and non-dose-related AC burden scores have limited sensitivity and modest PPV for screening a patient's medication for POD. However, given the additional effort required for dose consideration, the non-dose-related GerACB remains sufficient in clinical practice, with the lowest sensitivity but highest PPV.

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抗胆碱能暴露、药物剂量与术后谵妄：骨科和创伤外科老年患者回顾性队列研究中与剂量相关和非剂量相关的抗胆碱能负担评分的比较》，《美国医学会杂志》，2009 年，第 4 期。

目的：术后谵妄（POD）是老年患者术后常见的并发症。患者术前的抗胆碱能（AC）负担是导致 POD 的潜在风险因素。由于药物剂量的影响尚不清楚，我们旨在比较三种抗胆碱能药负担评分与 POD 的关系，其中两种与剂量有关：这项回顾性队列研究（03/22-10/22）纳入了年龄大于 65 岁的骨科和创伤外科患者。使用四A测试（4AT）、谵妄诊断和病历审查评估POD。使用非剂量相关的德国抗胆碱能负担评分（GerACB）、剂量相关的肌卡因乙酰胆碱能受体拮抗剂暴露扩展量表（extMARANTE）和剂量相关的德国药物负担指数（GerDBI）确定抗胆碱能负担。多变量逻辑回归分析确定了术前 AC 负担与 POD 之间的关系。使用卡帕统计、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）对评分进行比较：结果：385 例患者中有 71 例（18.4%）出现 POD。在对年龄、性别、痴呆、术前身体状况和处方药数量进行调整后，在所有三个评分中，高 AC 负担与 POD 显著相关（P < 0.001）。各负担分类之间的总体一致性很高（无 POD：κ = 0.645，有 POD：κ = 0.632）。GerACB的灵敏度最低，为23.9%（extMARANTE：42.3%，GerDBI：40.8%），但PPV最高，为48.6%（extMARANTE：38.5%，GerDBI：43.3%）：结论：剂量相关和非剂量相关 AC 负担评分在筛选 POD 患者用药方面的灵敏度有限，PPV 不高。然而，考虑到考虑剂量所需的额外工作，非剂量相关的 GerACB 在临床实践中仍然足够，其灵敏度最低，但 PPV 最高。

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

Drugs & Aging 医学-老年医学

CiteScore

5.50

自引率

7.10%

发文量

审稿时长

6-12 weeks

期刊介绍： Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.