title: Impact of institutionalization and anticholinergic medication on postoperative morbidity for major colorectal resections.
abstract: BACKGROUND
  Institutionalized patients pose various surgical difficulties as many have conditions requiring psychiatric medications with the propensity for anticholinergic side effects. This study was initiated to determine the impact of institutionalization and anticholinergic medication on postoperative outcomes.
  
  
  METHODS
  A total of 430 colorectal resection cases from 2006 to 2012 were studied. Among them, 19 were institutionalized patients and 17 were on long-term anticholinergic medications. Surgical outcomes were quantified by Clavien scoring, need for reoperations and postoperative deaths.
  
  
  RESULTS
  Patients who were institutionalized or on anticholinergic medication were more likely to have increased postoperative morbidity requiring invasive interventions or worse (Clavien score ≥ 3; odds ratios 5.02 and 3.63, 95% confidence intervals 1.93-13.06 and 1.29-10.21 respectively). However, only institutionalization was found to be an independent risk factor.
  
  
  CONCLUSIONS
  This study identified institutionalized patients as a higher risk group associated with postoperative complications compared to patients from the community. Thus, they merit a more thorough preoperative optimization closer postoperative monitoring regime.
authors.affiliation: Department of Surgery, Khoo Teck Puat Hospital, Singapore. Electronic address: gregory.heng@mohh.com.sg.
authors.forename: Gregory
authors.initials: G
authors.lastname: Heng
authors.affiliation: Department of Surgery, Khoo Teck Puat Hospital, Singapore.
authors.forename: Kok-Yang
authors.initials: KY
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D007326:Institutionalization; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D018680:Cholinergic Antagonists
keywords: colorectal resection; institutionalization; postoperative morbidity