Anti-cholinergic burden and patient related clinical outcomes in an emergency general surgical setting

Andrew D. Ablett, Aimee Browning, Vincent Quan, Hui S. Tay, Caroline McCormack, Ben Carter, Jonathan Hewitt (Corresponding Author), Phyo K. Myint (Corresponding Author), Older Persons Surgical Outcomes Collaboration (OPSOC)

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Background/Objective: The impact of medications with anti-cholinergic properties on outcomes in unselected adult patients admitted the emergency general surgical setting has not been investigated. Methods: All cases were identified prospectively from unselected adult patients admitted to the emergency general surgical ward between May to July 2016 in a UK centre with a catchment population circa 500,000. Prescribed medication lists were ascertained from case notes and electronic medical records. Anti-Cholinergic Burden (ACB) was calculated from medication lists. Patients were categorised into three groups based on ACB burden from medications; none (ACB score of 0); moderate (up to ACB score of two); high (ACB score more than two). The effect of increasing anticholinergic burden on selected outcomes of 30- and 90-day mortality, readmission within 30 days of discharge and length of hospital stay were examined using multivariable logistic regression models. Results: The 452 patients had a mean age (SD) of 51.7 (±20.6) years, 273 (60.4%) patients had no ACB burden, 106 (23.5%) had a ACB burden of up to two; and 73 (16.2%) had an ACB burden of > two. Multivariable analyses showed no association between high ACB burden and 90-day (fully adjusted odds ratio [OR] 0.56 (95%CI 0.12-2.85); P=0.48) and 30-day mortality (fully adjusted OR = 0.75 (95%CI 0.05-11.04); P=0.84). A significant association was observed between moderate ACB burden and 30-day readmission (fully adjusted OR = 2.01 (95%CI 1.09-3.71); P=0.03). Conclusions: Anti-cholinergic burden may be linked to hospital readmission in adults admitted to an emergency general surgical ward.
Original languageEnglish
Pages (from-to)527-534
Number of pages8
JournalAsian Journal of Surgery
Issue number4
Early online date10 Nov 2018
Publication statusPublished - Apr 2019


  • anti-cholinergic burden
  • 30-day mortality
  • 90-day mortality
  • 30-day readmission
  • length of hospital stay
  • change in destination
  • emergency surgery
  • 90-Day mortality
  • Anti-Cholinergic Burden
  • 30-Day mortality
  • Change in destination
  • Length of hospital stay
  • 30-Day readmission
  • Emergency surgery
  • RISK
  • CARE


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