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Asian J Surg. 2018 Nov 10. pii: S1015-9584(18)30520-7. doi: 10.1016/j.asjsur.2018.10.005. [Epub ahead of print]

Anti-cholinergic burden and patient related clinical outcomes in an emergency general surgical setting.

Author information

1
Institute of Applied Health Sciences, University of Aberdeen, UK.
2
Department of Population Medicine, Cardiff University, UK.
3
Department of Surgery, Dorset County Hospital, Dorchester, UK.
4
Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
5
NHS Grampian, Foresterhill Road, Foresterhill, Aberdeen, UK.
6
Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, UK.
7
Department of Population Medicine, Cardiff University, UK. Electronic address: hewittj2@cardiff.ac.uk.
8
Institute of Applied Health Sciences, University of Aberdeen, UK; NHS Grampian, Foresterhill Road, Foresterhill, Aberdeen, UK.

Abstract

BACKGROUND/OBJECTIVE:

The impact of medications with anti-cholinergic properties on morbidity and mortality of unselected adult patients admitted to the emergency general surgical setting has not been investigated.

METHODS:

All cases were identified prospectively from unselected adult patients admitted to the emergency general surgical ward between May to July 2016 in a UK centre with a catchment population circa 500,000. Prescribed medication lists were ascertained from case notes and electronic medical records. Anti-Cholinergic Burden (ACB) was calculated from medication lists. Patients were categorised into three groups based on ACB; none (ACB score of 0); moderate (up to ACB score of two); high (ACB score more than two). The effect of increasing ACB on selected outcomes of 30- and 90-day mortality, hospital readmission within 30-days of discharge and increased length of hospital stay were examined using multivariable logistic regression models.

RESULTS:

The 452 patients had a mean age (SD) of 51.7 (±20.6) years, 273 (60.4%) patients had no ACB burden, 106 (23.5%) had a ACB burden of up to two; and 73 (16.2%) had an ACB burden of > 2. Multivariable analyses showed no association between high ACB burden and 90-day (fully adjusted odds ratio [OR] 0.56 (95%CI 0.12-2.85); P = 0.48) and 30-day mortality (fully adjusted OR = 0.75 (95%CI 0.05-11.04); P = 0.84). A significant association was observed between moderate ACB burden and 30-day hospital readmission (fully adjusted OR = 2.01 (95%CI 1.09-3.71); P = 0.03).

CONCLUSIONS:

Anti-cholinergic burden may be linked to hospital readmission in adults admitted to an emergency general surgical ward.

KEYWORDS:

30-Day mortality; 30-Day readmission; 90-Day mortality; Anti-Cholinergic Burden; Change in destination; Emergency surgery; Length of hospital stay

PMID:
30420155
DOI:
10.1016/j.asjsur.2018.10.005
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