Preoperative medication use and development of postoperative delirium and cognitive dysfunction

Clin Transl Sci. 2021 Sep;14(5):1830-1840. doi: 10.1111/cts.13031. Epub 2021 May 2.

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.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Emergence Delirium / diagnosis
  • Emergence Delirium / epidemiology*
  • Emergence Delirium / etiology
  • Female
  • Humans
  • Male
  • Mental Status and Dementia Tests
  • Polypharmacy
  • Postoperative Cognitive Complications / diagnosis
  • Postoperative Cognitive Complications / epidemiology*
  • Postoperative Cognitive Complications / etiology
  • Potentially Inappropriate Medication List
  • Preoperative Period
  • Prospective Studies