Related Experiment Video
Updated: Jun 3, 2025

A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
Polypharmacy and anticholinergic burden as risk factors for postoperative delirium in surgical medicine
Henriette Louise Moellmann1, Soufian Boulghoudan2, Julian Kuhlmann2
1Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. henriettelouise.moellmann@med.uni-duesseldorf.de.
Purpose:
Polypharmacy is a widespread phenomenon in older patients. In particular, the anticholinergic burden of medication is an important risk factor for delirium due to age-related changes in the cholinergic system.
Methods:
Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.
Results:
The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2 years, respectively. Antidepressants odds ratio (OR) 3.16 (95% confidence interval. CI, 1.51-6.64), antidiabetic drugs OR 2.53 (95% CI 1.27-5.03), neuroleptics OR 3.52 (95% CI 1.70-7.28) and Parkinson medication OR 5.88 (95% CI 1.95-17.7) showed a significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43 patients (10.4%). The delirium rate was 25.6% (n = 11) and 11.0% (n = 40) had no anticholinergic burden. A significant correlation can be demonstrated with χ2(1) = 7.52, p = 0.006, Cramer's V = 0.136. There was a 2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31-5.97).
Conclusion:
The standardized recording of medication is essential, especially when identifying patients at risk of suffering from delirium. The use of the ACB score to assess the anticholinergic burden is a simple and reliable screening tool and should be part of a preoperative geriatric assessment.
Related Concept Videos
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Stages of General Anesthesia
General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Drug Therapy
Antianxiety Medications
Skeletal Muscle Relaxants: Adverse Effects
Unlike...
Depolarizing Blockers: Pharmocokinetics

