title: Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment.
abstract: Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA).
  
  
  
  A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R(2). Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC).
  
  
  
  Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ(2) = 3.842, p = 0.871 for model I and χ(2) = 8.130, p = 0.421 for model II). The Nagelkerke R(2) effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R(2)effect size of 0.174 and AUROC of 0.819.
  
  
  
  These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.
authors.affiliation: College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.|Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Jeong
authors.affiliation: Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
authors.forename: Eunsook
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
authors.forename: Kwang-Il
authors.initials: KI
authors.lastname: Kim
authors.affiliation: College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
authors.forename: Jee Eun
authors.initials: JE
authors.lastname: Chung
authors.affiliation: Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea.
authors.forename: Hae
authors.initials: H
authors.lastname: In Park
authors.affiliation: College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
authors.forename: Byung Koo
authors.initials: BK
authors.lastname: Lee
authors.affiliation: College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea. hsgwak@ewha.ac.kr.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Gwak
mesh_terms: D000368:Aged; D003693:Delirium / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000592:standards; D008875:Middle Aged; D019338:Polypharmacy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D056910:Republic of Korea; D012307:Risk Factors; D000071077:Surgical Oncology / Q000379:methods / Q000706:statistics & numerical data
keywords: Comprehensive geriatric assessment; Post-operative delirium; Pre-operative medication