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

• Published in: Clinical interventions in aging 2022-01, Vol.17, p.1931-1938
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Aged patients; Aged, 80 and over; Aging; anesthesia; Atropine; atropinic burden; Care and treatment; Cognitive ability; Complications; Complications and side effects; Consciousness; Delirium; Dementia; Drugs; Emergence Delirium; Fractures; Geriatrics; hip fracture; Hip Fractures - complications; Hip Fractures - surgery; Hip joint; Hospitals; Humans; Hyperthermia; Life Sciences; Morphine; Mortality; Multivariate analysis; Muscarinic Antagonists; Older people; Original Research; Patients; Physical restraints; post-operative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Regression analysis; Retention; Risk Factors; Software; Statistical analysis; Surgery; Trauma; Urine; Variables
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S372400

Postoperative 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 . 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 . 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 was 54% (36/67). The demographic characteristics were comparable between and no groups. Univariate analysis showed statistically significant differences between no and 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 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 with an area under ROC curve of 0.73 (95% CI: 0.61-0.83; p = 0.0001). Contrary to a prior exposure to atropinic drugs, a postoperative atropinic burden >2 was associated with postoperative in elderly patients with hip fracture. Postoperative administration of (new) antimuscarinic drugs is a precipitating factor of that could be avoided.