This study performed a retrospective longitudinal analysis of patients undergoing elective cardiac surgery at a tertiary care centre from January 2021 to January 2022. The Deyo-Charlson comorbidity index (D-CCI) was used to estimate the burden of comorbidities. The anticholinergic burden was assessed using the Anticholinergic Cognitive Burden scale (ACB) and Drug Burden Index (DBI) scale. All-cause postdischarge mortality was determined from electronic medical records.
A total of 255 older adults who had undergone elective cardiac surgery and had been followed up for at least 6 months were included in this study. Approximately 12.5% (n = 32) of older patients died within 6 months of discharge. In multivariate Cox regression analysis, ACB (HR:1.31, 95%CI:1.10-1.56 p = 0.01) and DBI (HR:2.08, 95%CI:1.27-3.39 p = 0.01) showed significantly increased risk of 6-month postdischarge mortality after adjusting for several possible confounders (age, gender, D-CCl, and American Society of Anaesthesiologists (ASA) score). Overall event-free survival differed significantly between patients undergoing cardiac surgery based on anticholinergic burden according to the group-stratified ACB and DBI scales (χ2: 5.907, log-rank test, p = 0.015 and χ2: 15.389, log-rank test, p < 0.001 respectively).
The anticholinergic burden is associated with 6-month all-cause post-discharge mortality in older cardiac surgery patients. A deprescribing approach should be considered, especially for older adults in the perioperative period.
The trial was retrospectively registered at ClinicalTrials.gov. Identifier: NCT05312684 Registered on 5 April 2022.
■这项研究对2021年1月至2022年1月在三级护理中心接受择期心脏手术的患者进行了回顾性纵向分析。Deyo-Charlson合并症指数(D-CCI)用于估计合并症的负担。使用抗胆碱能认知负担量表(ACB)和药物负担指数(DBI)量表评估抗胆碱能负担。根据电子病历确定全因出院后死亡率。
■本研究纳入了255名接受了选择性心脏手术并随访至少6个月的老年人。大约12.5%(n=32)的老年患者在出院后6个月内死亡。在多元Cox回归分析中,ACB(HR:1.31,95CI:1.10-1.56p=0.01)和DBI(HR:2.08,95CI:1.27-3.39p=0.01)在校正了几种可能的混杂因素后,显示出出院后6个月死亡率的风险显着增加(年龄,性别,D-CCl,和美国麻醉医师协会(ASA)评分)。根据分组分层ACB和DBI量表的抗胆碱能负荷,接受心脏手术的患者之间的总无事件生存率存在显着差异(χ2:5.907,对数秩检验,p=0.015和χ2:15.389,对数秩检验,p分别<0.001)。
■抗胆碱能负荷与老年心脏手术患者6个月全因出院后死亡率相关。应该考虑一种无效的方法,尤其是围手术期的老年人。