부산대학교 도서관

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. Methods Orthopaedic and trauma surgery patients aged [greater than or equal to] 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. 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.sup.2, 1 point), anticholinergic burden (ACB-score [greater than or equal to] 3, 1 point), and delirium risk-increasing drugs (n [greater than or equal to] 2; 2 points). Patients with [greater than or equal to] 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. 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. Keywords: Medication Safety, Geriatrics, Screening tools, Postoperative delirium
Author(s): Carolin Gessele[sup.1,2] , Thomas Saller[sup.3] , Vera Smolka[sup.4] , Konstantinos Dimitriadis[sup.5] , Ute Amann[sup.6] and Dorothea Strobach[sup.1,2] Introduction Delirium is defined as an acute change in attention, awareness, and [...]