Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment

Young Chul Youn, Hae Won Shin, Byung Sun Choi, Sangyun Kim, Jung Yeop Lee, Yong Chan Ha

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery. Methods: Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD. Results: Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95% CI: 0.074–0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications. Conclusion: Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status.

Original languageEnglish
Pages (from-to)1079-1084
Number of pages6
JournalInternational Journal of Geriatric Psychiatry
Volume32
Issue number10
DOIs
StatePublished - 1 Oct 2017

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Rivastigmine
Delirium
Incidence
Hip Fractures
Cognitive Dysfunction

Keywords

  • acetylcholinesterase inhibitors
  • cognitive impairment
  • delirium
  • postoperative delirium
  • risk factor

Cite this

Youn, Young Chul ; Shin, Hae Won ; Choi, Byung Sun ; Kim, Sangyun ; Lee, Jung Yeop ; Ha, Yong Chan. / Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment. In: International Journal of Geriatric Psychiatry. 2017 ; Vol. 32, No. 10. pp. 1079-1084.
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abstract = "Objective: To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery. Methods: Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD. Results: Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95{\%} CI: 0.074–0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications. Conclusion: Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status.",
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Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment. / Youn, Young Chul; Shin, Hae Won; Choi, Byung Sun; Kim, Sangyun; Lee, Jung Yeop; Ha, Yong Chan.

In: International Journal of Geriatric Psychiatry, Vol. 32, No. 10, 01.10.2017, p. 1079-1084.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Rivastigmine patch reduces the incidence of postoperative delirium in older patients with cognitive impairment

AU - Youn, Young Chul

AU - Shin, Hae Won

AU - Choi, Byung Sun

AU - Kim, Sangyun

AU - Lee, Jung Yeop

AU - Ha, Yong Chan

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N2 - Objective: To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery. Methods: Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD. Results: Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95% CI: 0.074–0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications. Conclusion: Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status.

AB - Objective: To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery. Methods: Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD. Results: Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95% CI: 0.074–0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications. Conclusion: Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status.

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