Preoperative medication use and development of postoperative delirium and cognitive dysfunction

Heinrich, M.; Nottbrock, A.; Borchers, F.; Mörgeli, R.; Kruppa, J.; Winterer, G.; Slooter, A.J.C.; Spies, C.

Preoperative medication use and development of postoperative delirium and cognitive dysfunction

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Item Type:	Article
Title:	Preoperative medication use and development of postoperative delirium and cognitive dysfunction
Creators Name:	Heinrich, M., Nottbrock, A., Borchers, F., Mörgeli, R., Kruppa, J., Winterer, G., Slooter, A.J.C. and Spies, C.
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 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.
Keywords:	Emergence Delirium, Mental Status and Dementia Tests, Polypharmacy, Postoperative Cognitive Complications, Potentially Inappropriate Medication List, Preoperative Period, Prospective Studies
Source:	Clinical and Translational Science
ISSN:	1752-8054
Publisher:	Wiley
Volume:	14
Number:	5
Page Range:	1830-1840
Date:	September 2021
Official Publication:	https://doi.org/10.1111/cts.13031
PubMed:	View item in PubMed

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