Atropine Weight and Risk of Postoperative Confusion in the Elderly

University Hospital, Toulouse130 enrolled

Overview

The identification of a high atropine load of treatment received during hospitalization as a predictor of postoperative confusion could have various benefits: * Pharmacoepidemiological: identify factors associated with postoperative confusion * Clinics: by favoring treatments with a low atropine load during anesthesia, the management of patients hospitalized in orthopedics. Similarly, stopping or re-evaluating treatments with a high atropine weight for scheduled surgery is an easy step to take. * Socio-economic: by reducing the costs related to the occurrence of a confusional syndrome (over-treatment, prolonged hospital stay, loss of autonomy, institutionalization of patients...). In total, the present study would improve the daily management of hospitalized patients and the practices of clinicians, by offering a decision-making aid.

Study Type

OBSERVATIONAL

Enrollment

130

Conditions

Aging

Interventions

Data collectionOTHER

The collection of data will be done by interrogation of the patient and his family / entourage and rereading of medical records

Medical Language ↔ Plain English

Inclusion Criteria: * Admitted to the orthopedic department for surgical management of a fracture of the upper end of the femur in emergency or for the installation of a hip or knee prosthesis * Patient able to understand and respond to the protocol * No opposition to the collection of data of the patient or his / her designee Exclusion Criteria: * Pre-existing confusion to surgery, detected by the CAM scale * Serious or moderate head trauma less than three months old * Removing / installing prosthesis.

Outcomes

Primary Outcomes

Association between atropine load of medications on the risk of postoperative confusion

Occurrence of a postoperative confusion syndrome performed by Confusion Assessment Method (CAM) scale once a day. The CAM is a validated scale as a diagnostic scale for confusional syndrome at the patient's bedside with four parts : 1) confusion and fluctuation of symptoms, 2) inattention, 3) disorganization of thought, 4) disorder of consciousness.

Time frame: up to 7 days

Atropinic load of drugs

The DURAN scale is the most recent and most comprehensive atropine load evaluation scale. This scale classifies the evaluated drugs into three categories: no anticholinergic power (atropine weight = 0), low anticholinergic activity (atropine weight = 1), high atropinic power (atropine weight = 3). All drugs received by the patient during 7 days will be classified with the Duran scale.

Time frame: up to 7 days

Secondary Outcomes

Duration of hospitalization

Number of days of hospitalization (days) between surgery and discharge. Association between atropinic load of drugs and duration of hospitalization will be evaluated.

Time frame: Up to discharge, an average of ten days

Autonomy

Description of autonomy of the patient at three months of surgery evaluated by the Activity Daily Living scale (ADL). The ADL scale evaluates activities of daily living: washing, dressing, going to the bathroom, ensuring transfers, continence and food. Each item is rated according to a level of dependence: independent (1 point), with assistance (0.5 points), unable to achieve (0 points). A total of 6 points indicates a total autonomy, and 0 a total dependency.

Time frame: Month 3

Cognitive dysfunction

Appearance postoperative cognitive dysfunction by the Mini Mental State (MMS). the total score of MMS wil be collected.

Time frame: baseline