Anticholinergic drugs are common in older adults and linked to cognitive decline, frailty, longer hospital stay, and higher mortality. This cumulative burden, often increased by anesthetics and analgesics, may worsen during surgery. The study evaluates whether reducing perioperative anticholinergic load improves recovery after cardiac surgery.
Anticholinergic agents are frequently prescribed in older adults and have been linked to negative outcomes such as cognitive decline, frailty, extended hospitalization, and increased mortality. The cumulative exposure, referred to as anticholinergic burden, may be exacerbated during the perioperative period due to anesthetic and analgesic use. This trial explores whether minimizing perioperative anticholinergic burden can improve postoperative recovery following cardiac surgery. In this prospective, randomized controlled study, 120 patients aged 60 years or older undergoing isolated coronary artery bypass grafting with a preoperative Anticholinergic Cognitive Burden score of ≥3 were included. Participants were assigned either to standard perioperative care involving anesthetic and analgesic agents with anticholinergic activity (Group Standard) or to a deprescribing protocol excluding all anticholinergic drugs intraoperatively and postoperatively (Group Deprescribing). The primary endpoints were functional recovery assessed at 90 days using the Katz Index and Clinical Frailty Scale. Secondary endpoints comprised hospital length of stay, 90-day incidence of cardiac and pulmonary complications, intensive care Unit stay, duration of mechanical ventilation, additional complications, and 90-day mortality. The Wilcoxon signed-rank test was used for paired comparisons of Katz and frailty scores, while multivariate logistic regression was applied to identify independent predictors of postoperative cardiac complications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
120
In the intraoperative and postoperative periods instead of drugs with high anticholinergic burden; drugs with low burden will be preferred.
Aslihan Aykut
Ankara, çankaya, Turkey (Türkiye)
Katz Index of Independence in Activities of Daily Living and Clinical Frailty Scale (CFS)
The Katz Index of Independence in Activities of Daily Living evaluates a patient's ability to perform six basic functions: bathing, dressing, toileting, transferring, continence, and feeding. Each activity is scored as either "independent" (1 point) or "dependent" (0 points). The total score reflects the patient's overall level of functional independence. The Clinical Frailty Scale (CFS) is a validated 9-point tool used to assess a patient's baseline frailty status. It evaluates physical fitness, comorbidity burden, functional dependence, and overall health status. Scores range from 1 (Very Fit) to 9 (Terminally Ill). Higher scores indicate greater frailty and worse baseline physiological reserve.
Time frame: Postoperative day 90
Intensive Care Unit Length of Stay (days)
The duration of stay in the intensive care unit, measured in days, from ICU admission after surgery until ICU discharge.
Time frame: From postoperative ICU admission until ICU discharge (typically within 1-3 days).
Duration of Mechanical Ventilation (hours)
The duration of postoperative mechanical ventilation, measured in hours, from end of surgery until successful extubation.
Time frame: From the end of surgery to extubation
other postoperative complications
Occurrence of postoperative complications within 90 days after surgery, including neurological (stroke, transient ischemic attack, seizures), renal (acute kidney injury, need for renal replacement therapy, chronic renal failure), and infectious complications (pneumonia, mediastinitis, meningitis, urinary tract infection, wound infection, catheter-related sepsis), as well as delirium.
Time frame: From completion of surgery to postoperative day 90
all-cause mortality
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All-cause mortality occurring within 90 days after surgery.
Time frame: From completion of surgery to postoperative day 90
Change in Katz Index of Independence in Activities of Daily Living From Baseline
The change in Katz Index score will be calculated as the postoperative day 90 score minus the preoperative baseline score. The Katz Index ranges from 0 (highly dependent) to 6 (independent). Higher scores indicate better functional independence.
Time frame: Baseline (preoperative) to postoperative day 90
Postoperative major cardiac complications
Incidence of major postoperative cardiac complications, including cardiac arrest, myocardial infarction, arrhythmia, and aortic dissection.
Time frame: From completion of surgery to postoperative day 90
Hospital length of stay (days)
Duration of postoperative hospital stay, measured in days, from admission to the hospital after surgery until hospital discharge.
Time frame: From hospital admission for surgery until hospital discharge (typically within 5-10 days).
Incidence of major pulmonary complications
Major postoperative pulmonary complications, including pneumothorax, pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS).
Time frame: From completion of surgery to postoperative day 90
Change in Clinical Frailty Scale (CFS) from baseline
Change in Clinical Frailty Scale (CFS) score from preoperative baseline to postoperative day 90. The CFS is a nine-point scale assessing mobility, energy, physical activity, and overall functional health: 1. = Very Fit 2. = Well 3. = Managing Well 4. = Vulnerable 5. = Mildly Frail 6. = Moderately Frail 7. = Severely Frail 8. = Very Severely Frail 9. = Terminally Ill Higher scores indicate greater frailty.
Time frame: Baseline (preoperative) to postoperative day 90