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Development and validation of a new drug-focused predictive risk score for postoperative delirium in orthopaedic and trauma surgery patients.
- Source :
-
BMC geriatrics [BMC Geriatr] 2024 May 13; Vol. 24 (1), pp. 422. Date of Electronic Publication: 2024 May 13. - Publication Year :
- 2024
-
Abstract
- Background: Postoperative delirium (POD) is the most common complication following surgery in elderly patients. During pharmacist-led medication reconciliation (PhMR), a predictive risk score considering delirium risk-increasing drugs and other available risk factors could help to identify risk patients.<br />Methods: Orthopaedic and trauma surgery patients aged ≥ 18 years with PhMR were included in a retrospective observational single-centre study 03/2022-10/2022. The study cohort was randomly split into a development and a validation cohort (6:4 ratio). POD was assessed through the 4 A's test (4AT), delirium diagnosis, and chart review. Potential risk factors available at PhMR were tested via univariable analysis. Significant variables were added to a multivariable logistic regression model. Based on the regression coefficients, a risk score for POD including delirium risk-increasing drugs (DRD score) was established.<br />Results: POD occurred in 42/328 (12.8%) and 30/218 (13.8%) patients in the development and validation cohorts, respectively. Of the seven evaluated risk factors, four were ultimately tested in a multivariable logistic regression model. The final DRD score included age (66-75 years, 2 points; > 75 years, 3 points), renal impairment (eGFR < 60 ml/min/1.73m <superscript>2</superscript> , 1 point), anticholinergic burden (ACB-score ≥ 3, 1 point), and delirium risk-increasing drugs (n ≥ 2; 2 points). Patients with ≥ 4 points were classified as having a high risk for POD. The areas under the receiver operating characteristic curve of the risk score model were 0.89 and 0.81 for the development and the validation cohorts, respectively.<br />Conclusion: The DRD score is a predictive risk score assessable during PhMR and can identify patients at risk for POD. Specific preventive measures concerning drug therapy safety and non-pharmacological actions should be implemented for identified risk patients.<br /> (© 2024. The Author(s).)
- Subjects :
- Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Acute Care Surgery
Medication Reconciliation methods
Retrospective Studies
Risk Assessment methods
Risk Factors
Wounds and Injuries surgery
Orthopedic Procedures adverse effects
Orthopedic Procedures methods
Emergence Delirium diagnosis
Emergence Delirium prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2318
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC geriatrics
- Publication Type :
- Academic Journal
- Accession number :
- 38741037
- Full Text :
- https://doi.org/10.1186/s12877-024-05005-1