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

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.