Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment

Young Mi Jeong, Eunsook Lee, Kwang-Il Kim, Jee Eun Chung, Hae In Park, Byung Koo Lee, Hye Sun Gwak

Research output: Contribution to journalArticleResearchpeer-review

16 Citations (Scopus)

Abstract

Background: Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). Methods: A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R2. Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Results: Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ2 = 3.842, p = 0.871 for model I and χ2 = 8.130, p = 0.421 for model II). The Nagelkerke R2 effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R2effect size of 0.174 and AUROC of 0.819. Conclusions: These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalBMC Geriatrics
Volume16
Issue number1
DOIs
StatePublished - 1 Jan 2016

Fingerprint

Geriatric Assessment
Delirium
Surgical Oncology
Polypharmacy
Pharmacists
Diagnostic and Statistical Manual of Mental Disorders
Psychiatry
Dementia

Keywords

  • Comprehensive geriatric assessment
  • Post-operative delirium
  • Pre-operative medication

Cite this

Jeong, Young Mi ; Lee, Eunsook ; Kim, Kwang-Il ; Chung, Jee Eun ; In Park, Hae ; Lee, Byung Koo ; Gwak, Hye Sun. / Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. In: BMC Geriatrics. 2016 ; Vol. 16, No. 1. pp. 1-8.
@article{b99c9d1ab58145b1bc85c6eef47da6ba,
title = "Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment",
abstract = "Background: Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). Methods: A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R2. Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Results: Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 {\%} CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 {\%} CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ2 = 3.842, p = 0.871 for model I and χ2 = 8.130, p = 0.421 for model II). The Nagelkerke R2 effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R2effect size of 0.174 and AUROC of 0.819. Conclusions: These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.",
keywords = "Comprehensive geriatric assessment, Post-operative delirium, Pre-operative medication",
author = "Jeong, {Young Mi} and Eunsook Lee and Kwang-Il Kim and Chung, {Jee Eun} and {In Park}, Hae and Lee, {Byung Koo} and Gwak, {Hye Sun}",
year = "2016",
month = "1",
day = "1",
doi = "10.1186/s12877-016-0311-5",
language = "English",
volume = "16",
pages = "1--8",
journal = "BMC Geriatrics",
issn = "1471-2318",
publisher = "BioMed Central Ltd.",
number = "1",

}

Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. / Jeong, Young Mi; Lee, Eunsook; Kim, Kwang-Il; Chung, Jee Eun; In Park, Hae; Lee, Byung Koo; Gwak, Hye Sun.

In: BMC Geriatrics, Vol. 16, No. 1, 01.01.2016, p. 1-8.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment

AU - Jeong, Young Mi

AU - Lee, Eunsook

AU - Kim, Kwang-Il

AU - Chung, Jee Eun

AU - In Park, Hae

AU - Lee, Byung Koo

AU - Gwak, Hye Sun

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). Methods: A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R2. Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Results: Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ2 = 3.842, p = 0.871 for model I and χ2 = 8.130, p = 0.421 for model II). The Nagelkerke R2 effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R2effect size of 0.174 and AUROC of 0.819. Conclusions: These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

AB - Background: Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). Methods: A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R2. Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Results: Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ2 = 3.842, p = 0.871 for model I and χ2 = 8.130, p = 0.421 for model II). The Nagelkerke R2 effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R2effect size of 0.174 and AUROC of 0.819. Conclusions: These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

KW - Comprehensive geriatric assessment

KW - Post-operative delirium

KW - Pre-operative medication

UR - http://www.scopus.com/inward/record.url?scp=84992061333&partnerID=8YFLogxK

U2 - 10.1186/s12877-016-0311-5

DO - 10.1186/s12877-016-0311-5

M3 - Article

VL - 16

SP - 1

EP - 8

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

IS - 1

ER -