Preoperative medication use and development of postoperative delirium and cognitive dysfunction
BioCog consortium
(2021) Clinical and Translational Science, volume 14, issue 5, pp. 1830 - 1840
(Article)
Abstract
Postoperative delirium (POD) and postoperative (neuro-)cognitive disorder (POCD) are frequent and serious complications after operations. We aim to investigate the association between pre-operative polypharmacy and potentially inappropriate medications and the development of POD/POCD in elderly patients. This investigation is part of the European BioCog project (www.biocog.eu), a prospective multicenter observational
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study with elderly surgical patients. Patients with a Mini-Mental State Examination score less than or equal to 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method (for the intensive care unit [ICU]), and a patient chart review. POCD was assessed 3 months after surgery with a neuropsychological test battery. Pre-operative long-term medication was evaluated in terms of polypharmacy (≥5 agents) and potentially inappropriate medication (defined by the PRISCUS and European list of potentially inappropriate medications [EU(7)-PIM] lists), and associations with POD and POCD were analyzed using logistic regression analysis. Eight hundred thirty-seven participants were included for analysis of POD and 562 participants for POCD. Of these, 165 patients (19.7%) fulfilled the criteria of POD and 60 (10.7%) for POCD. After adjusting for confounders, pre-operative polypharmacy and intake of potentially inappropriate medications could not be shown to be associated with the development of POD nor POCD. We found no associations between pre-operative polypharmacy and potentially inappropriate medications and development of POD and POCD. Future studies should focus on the evaluation of drug interactions to determine whether patients benefit from a pre-operative adjustment.
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Keywords: General Biochemistry,Genetics and Molecular Biology, General Neuroscience, Pharmacology, Toxicology and Pharmaceutics(all), Journal Article
ISSN: 1752-8054
Publisher: Wiley-Blackwell Publishing Ltd
Note: Funding Information: The authors thank Konstanze Scheurer (Charité‐Universitätsmedizin Berlin) for the administrative support with study coordination and management. Judy Veldhuijzen (UMC Utrecht), Antje Kraft (Charité Universitätsmedizin Berlin), Simone Kühn (University of Hamburg) and Insa Feinkohl (Max‐Delbrück Center Berlin) provided additional neuropsychological expertise. Kathrin Scholtz supported the study as the clinical monitor. Data management was provided by Olaf Bender and Alexander Krannich at Koordininierungszentrum für Klinische Studien (KKS Berlin) supported by Pharmaimage Biomarkers Solutions GmbH. Henning Krampe supported the study by recruiting and supervising students for neuropsychological testing. We thank our team of investigators, medical doctoral students and study nurses: Alissa Wolf, Fatima Yürek, Anika Müller, Daniel Hadzidiakos, 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, Leopold Rupp, Marie Graunke, and Victoria Windmann. The authors further wish to thank the team of the student and interns of the Department of Anesthesiology at the Charité‐Universitätsmedizin Berlin. Maria Heinrich is participant in the BIH‐Charité Digital Clinician Scientist Program funded by the Charité–Universitätsmedizin Berlin and the Berlin Institute of Health. Funding Information: This work was conducted with support of the European Union (Seventh Framework Programme) as part of the BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), no. 602461. The authors thank Konstanze Scheurer (Charit?-Universit?tsmedizin Berlin) for the administrative support with study coordination and management. Judy Veldhuijzen (UMC Utrecht), Antje Kraft (Charit? Universit?tsmedizin Berlin), Simone K?hn (University of Hamburg) and Insa Feinkohl (Max-Delbr?ck Center Berlin) provided additional neuropsychological expertise. Kathrin Scholtz supported the study as the clinical monitor. Data management was provided by Olaf Bender and Alexander Krannich at Koordininierungszentrum f?r Klinische Studien (KKS Berlin) supported by Pharmaimage Biomarkers Solutions GmbH. Henning Krampe supported the study by recruiting and supervising students for neuropsychological testing. We thank our team of investigators, medical doctoral students and study nurses: Alissa Wolf, Fatima Y?rek, Anika M?ller, Daniel Hadzidiakos, Ilse Kant, Simone van Montfort, Gunnar Lachmann, Anika Alon, Sina Rosenblender, Tuba Aslan, Markus Laubach, Felix M?ller, Emmanuel Keller, Eleftheria Papadaki, Saya Speidel, Bennet Borak, Steffi Herferth, Johannes Lange, Mario Lamping, Helene Michler, Juliane D?rfler, Anton Jacobshagen, Petra Kozma, Marinus Fislage, Wolf R?diger Brockhaus, Luisa Rothe, Pola Neuling, Ken-Dieter Michel, Zdravka Bosancic, Firas Nosirat, Maryam Kurpanik, Sophia Kuenz, Lukas Roediger, Irene Mergele, Leopold Rupp, Marie Graunke, and Victoria Windmann. The authors further wish to thank the team of the student and interns of the Department of Anesthesiology at the Charit?-Universit?tsmedizin Berlin. Maria Heinrich is participant in the BIH-Charit? Digital Clinician Scientist Program funded by the Charit??Universit?tsmedizin Berlin and the Berlin Institute of Health. Funding Information: This work was conducted with support of the European Union (Seventh Framework Programme) as part of the BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), no. 602461. Publisher Copyright: © 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics.
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