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A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial

BACKGROUND: Postoperative delirium frequently occurs in the elderly after hip fracture surgery and is associated with poor outcomes. Our aim was to identify a correlation between the atropinic burden (AB) due to drugs with clinical antimuscarinic effect and the occurrence of postoperative delirium....

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Autores principales: Ferré, Fabrice, Piel-Julian, Marie-Léa, Tincres, Francis, Ba, Cyndie, Menut, Rémi, Ferrier, Anne, Bosch, Laetitia, Martin, Charlotte, Labaste, François, Montastruc, François, Sommet, Agnès, Balardy, Laurent, Minville, Vincent
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809176/
https://www.ncbi.nlm.nih.gov/pubmed/36605703
http://dx.doi.org/10.2147/CIA.S372400
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author Ferré, Fabrice
Piel-Julian, Marie-Léa
Tincres, Francis
Ba, Cyndie
Menut, Rémi
Ferrier, Anne
Bosch, Laetitia
Martin, Charlotte
Labaste, François
Montastruc, François
Sommet, Agnès
Balardy, Laurent
Minville, Vincent
author_facet Ferré, Fabrice
Piel-Julian, Marie-Léa
Tincres, Francis
Ba, Cyndie
Menut, Rémi
Ferrier, Anne
Bosch, Laetitia
Martin, Charlotte
Labaste, François
Montastruc, François
Sommet, Agnès
Balardy, Laurent
Minville, Vincent
author_sort Ferré, Fabrice
collection PubMed
description BACKGROUND: Postoperative delirium frequently occurs in the elderly after hip fracture surgery and is associated with poor outcomes. Our aim was to identify a correlation between the atropinic burden (AB) due to drugs with clinical antimuscarinic effect and the occurrence of postoperative delirium. METHODS: We carried out a prospective, monocentric, observational study including 67 patients over 65 years of age who underwent hip fracture surgery. The addition of the anticholinergic weight of each drug was calculated at different time points to distinguish the prehospital, intra- and postoperative part of the AB. A multivariate analysis was carried out to identify the explanatory variables associated with postoperative delirium. RESULTS: Patients were 78 [71–86] years old. The time from admission to surgery was 12 [12–24] hours. The ADL and CIRS scores were 6 [5.5–6] and 6 [4–9], respectively. The total (prehospital plus intraoperative plus postoperative) AB was 5 [3–9]. The incidence of postoperative delirium was 54% (36/67). The demographic characteristics were comparable between delirium and no delirium groups. Univariate analysis showed statistically significant differences between no delirium and delirium groups concerning the number of prehospital atropinic drugs, prehospital AB, the number of postoperative atropinic drugs, postoperative AB, in-hospital AB and the MMSE calculated on postoperative day 5. Using multivariate analysis, postoperative AB, but not pre- and in-hospital ABs, was associated with postoperative delirium with an odds ratio of 1.84 (95% CI: 1.25–2.72; p = 0.002). A postoperative AB > 2 was associated with a postoperative delirium with an area under ROC curve of 0.73 (95% CI: 0.61–0.83; p = 0.0001). CONCLUSION: Contrary to a prior exposure to atropinic drugs, a postoperative atropinic burden >2 was associated with postoperative delirium in elderly patients with hip fracture. Postoperative administration of (new) antimuscarinic drugs is a precipitating factor of delirium that could be avoided.
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spelling pubmed-98091762023-01-04 A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial Ferré, Fabrice Piel-Julian, Marie-Léa Tincres, Francis Ba, Cyndie Menut, Rémi Ferrier, Anne Bosch, Laetitia Martin, Charlotte Labaste, François Montastruc, François Sommet, Agnès Balardy, Laurent Minville, Vincent Clin Interv Aging Original Research BACKGROUND: Postoperative delirium frequently occurs in the elderly after hip fracture surgery and is associated with poor outcomes. Our aim was to identify a correlation between the atropinic burden (AB) due to drugs with clinical antimuscarinic effect and the occurrence of postoperative delirium. METHODS: We carried out a prospective, monocentric, observational study including 67 patients over 65 years of age who underwent hip fracture surgery. The addition of the anticholinergic weight of each drug was calculated at different time points to distinguish the prehospital, intra- and postoperative part of the AB. A multivariate analysis was carried out to identify the explanatory variables associated with postoperative delirium. RESULTS: Patients were 78 [71–86] years old. The time from admission to surgery was 12 [12–24] hours. The ADL and CIRS scores were 6 [5.5–6] and 6 [4–9], respectively. The total (prehospital plus intraoperative plus postoperative) AB was 5 [3–9]. The incidence of postoperative delirium was 54% (36/67). The demographic characteristics were comparable between delirium and no delirium groups. Univariate analysis showed statistically significant differences between no delirium and delirium groups concerning the number of prehospital atropinic drugs, prehospital AB, the number of postoperative atropinic drugs, postoperative AB, in-hospital AB and the MMSE calculated on postoperative day 5. Using multivariate analysis, postoperative AB, but not pre- and in-hospital ABs, was associated with postoperative delirium with an odds ratio of 1.84 (95% CI: 1.25–2.72; p = 0.002). A postoperative AB > 2 was associated with a postoperative delirium with an area under ROC curve of 0.73 (95% CI: 0.61–0.83; p = 0.0001). CONCLUSION: Contrary to a prior exposure to atropinic drugs, a postoperative atropinic burden >2 was associated with postoperative delirium in elderly patients with hip fracture. Postoperative administration of (new) antimuscarinic drugs is a precipitating factor of delirium that could be avoided. Dove 2022-12-30 /pmc/articles/PMC9809176/ /pubmed/36605703 http://dx.doi.org/10.2147/CIA.S372400 Text en © 2022 Ferré et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Ferré, Fabrice
Piel-Julian, Marie-Léa
Tincres, Francis
Ba, Cyndie
Menut, Rémi
Ferrier, Anne
Bosch, Laetitia
Martin, Charlotte
Labaste, François
Montastruc, François
Sommet, Agnès
Balardy, Laurent
Minville, Vincent
A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title_full A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title_fullStr A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title_full_unstemmed A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title_short A High Postoperative Atropinic Burden is Associated with Postoperative Delirium in Elderly Patients with Hip Fracture: Results of the Prospective, Observational, ATROPAGE Trial
title_sort high postoperative atropinic burden is associated with postoperative delirium in elderly patients with hip fracture: results of the prospective, observational, atropage trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809176/
https://www.ncbi.nlm.nih.gov/pubmed/36605703
http://dx.doi.org/10.2147/CIA.S372400
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