Effects of potent anticholinergics, sedatives and antipsychotics on postoperative mortality in elderly patients with hip fracture: a retrospective, population-based study.
BACKGROUND
Concomitant use of several medications for somatic and mental disorders is common in elderly people and increases the risk of falls, with hip fracture being the most serious consequence.


OBJECTIVE
The objective of this study was to describe relationships between use of sedatives, antipsychotics or potent anticholinergics and postoperative mortality in patients with hip fractures.


METHODS
A retrospective analysis was conducted on population-based data collected during a 2-year period from 1999 to 2000 on 461 hip fracture surgery patients aged > or = 65 years in Finland. Information on co-morbidities and intake of sedatives, antipsychotics and potent anticholinergics was obtained from the original patient records. Information on deaths was obtained from the official death statistics in Finland.


RESULTS
In men, use of potent anticholinergics was associated with excess age-adjusted mortality at 30 days, 3 months, 6 months and 3 years, but not in women at any timepoint.


CONCLUSIONS
Use of potent anticholinergic drugs emerged as an independent predictor of excess mortality in men at 3 months and 3 years. Presence of cardiovascular disease and chronic lung disease were independent risk factors for excess mortality at 6 months and 3 years in men. In addition, chronic lung disease independently predicted excess mortality at 30 days. Use of potent anticholinergics should be evaluated critically after hip fracture surgery, especially in men with cardiovascular or chronic lung diseases.
Panula
Jorma
J
Department of Surgery, Pori City Hospital, Pori, Finland. jorma.panula@fimnet.fi
Puustinen
Juha
J
Jaatinen
Pekka
P
Vahlberg
Tero
T
Aarnio
Pertti
P
Kivela
Sirkka-Liisa
SL
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors
D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives