High-risk psychotropic medication use and delirium screening in older patients undergoing planned surgical procedures

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2025-04-10 DOI:10.1002/jppr.70004

Sally B. Marotti BPharm, Sona E. Shaji BPharm, Alanna Maguire BPharm, Angela Lovas-Tiong BPharm, Gizat M. Kassie BPharm, PhD, Anita Taylor MSc, Peter J. Smitham PhD, FRCS (Tr & Orth), FRACS, Lisa M. Kalisch Ellett BPharm, PhD

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引用次数: 0

Abstract

Background

A number of commonly used psychotropic medicines increase the risk of postoperative delirium. In some cases, these medicines could be safely tapered or held prior to planned surgery, which may reduce the incidence of postoperative delirium. However, the frequency with which patients use these medicines prior to planned surgery is unknown.

Aim

To determine the prevalence of opioid analgesic, antidepressant, gabapentinoid, and benzodiazepine use prior to planned surgery, the prevalence of delirium screening before and after planned surgery, and the incidence of postoperative delirium in older patients using high-risk medicines.

Method

We conducted a retrospective analysis of electronic medical records (EMRs) from four acute-care hospitals. Patients aged 65 years or older who underwent planned surgery over a 2-week period were included. Data relating to patient age, gender, type of surgical procedure, length of surgery, type of anaesthesia, medications on admission, and 4AT delirium tests were extracted from the EMRs. This project was exempt due to the local policy requirements that constitute research by the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (Reference no: CALHN19857). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's National statement on ethical conduct in human research, met local requirements for an audit activity, and presented no foreseeable risk of patient harm.

Results

The study included 158 participants with a median age of 75 years, of whom 41% were taking a medicine associated with increased risk of postoperative delirium prior to their planned surgical admission; 21% were taking an antidepressant, 15% an opioid analgesic, 13% a benzodiazepine, and 6% a gabapentinoid at the time of admission. In addition, 80% of participants had a 4AT test prior to surgery, and 61% received at least one 4AT test after surgery.

Conclusion

Among the older patients undergoing planned surgery, 41% used a medicine associated with increased risk of postoperative delirium, and not all older patients received delirium screening prior to or after surgery.

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高危精神药物的使用和接受计划手术的老年患者的谵妄筛查

一些常用的精神药物增加了术后谵妄的风险。在某些情况下，这些药物可以安全地逐渐减少或在计划手术前服用，这可能会减少术后谵妄的发生率。然而，患者在计划手术前使用这些药物的频率尚不清楚。目的了解老年高危用药患者术前阿片类镇痛药、抗抑郁药、加巴喷丁类药物和苯二氮卓类药物的使用情况，术前和术后谵妄筛查情况，术后谵妄发生率。方法对四家急症医院的电子病历进行回顾性分析。年龄在65岁或以上的患者在2周内接受了计划手术。从电子病历中提取与患者年龄、性别、手术类型、手术时间、麻醉类型、入院时用药和4AT谵妄试验有关的数据。由于阿德莱德中央地方卫生网络（CALHN）人类研究伦理委员会（参考编号：CALHN19857）的研究需要符合当地政策要求，因此该项目获得豁免。这项伦理豁免的理由如下：该项目符合国家卫生和医学研究委员会关于人体研究伦理行为的国家声明，符合当地审计活动的要求，并且不存在可预见的患者伤害风险。该研究纳入了158名中位年龄为75岁的参与者，其中41%的参与者在计划手术入院前服用了与术后谵妄风险增加相关的药物；入院时，21%服用抗抑郁药，15%服用阿片类镇痛药，13%服用苯二氮卓类药物，6%服用加巴喷丁类药物。此外，80%的参与者在手术前进行了4AT测试，61%的参与者在手术后至少接受了一次4AT测试。结论：在接受计划手术的老年患者中，41%的患者使用了与术后谵妄风险增加相关的药物，并不是所有的老年患者在手术前或术后都接受了谵妄筛查。

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

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.