Anticholinergic Burden as a Modifiable Risk Factor in Cardiac Surgery: A Randomized Controlled Study

Area of Science:

• Geriatric Medicine
• Cardiothoracic Surgery
• Pharmacology

Background:

• Older adults undergoing coronary artery bypass grafting (CABG) often experience anticholinergic medication burden.
• Anticholinergic drugs can negatively impact cognitive function and functional recovery.
• The preoperative Anticholinergic Cognitive Burden (ACB) score helps identify at-risk patients.

Purpose of the Study:

• To evaluate if reducing perioperative anticholinergic medication use improves functional recovery in elderly CABG patients.
• To assess the impact of a deprescribing strategy on functional outcomes and complications.

Main Methods:

• Prospective randomized controlled study involving 122 patients aged ≥60 years with ACB scores ≥3.
• Intervention group received a deprescribing strategy avoiding perioperative anticholinergic anesthetic and analgesic drugs.
• Control group received standard anesthetic and/or analgesic care including anticholinergic drugs.

Main Results:

• Significantly more patients in the deprescribing group achieved full independence (Katz Index score of 6) by postoperative day 90 (75.0% vs 41.1%, p < 0.001).
• Frailty scores were significantly lower in the deprescribing group at 90 days (median 3 vs 4, p < 0.001).
• Perioperative anticholinergic use was an independent predictor of 90-day complications (OR 2.430, p = 0.042).

Conclusions:

• Immediate perioperative deprescribing of anticholinergic medications improved 90-day functional recovery in older CABG patients.
• This strategy was associated with fewer cardiac and pulmonary complications.
• Reducing anticholinergic burden is a modifiable risk factor to optimize outcomes in elderly surgical patients.