Association of cholinesterase activities and POD in older adult abdominal surgical patients View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-09-16

AUTHORS

Zdravka Bosancic, Claudia D. Spies, Anika Müller, Georg Winterer, Sophie K. Piper, Maria Heinrich

ABSTRACT

BackgroundPostoperative delirium (POD) is a frequent complication after surgery. Older adult patients undergoing abdominal surgery are at higher risk for developing POD. Studies on the association of cholinesterase activities and POD are rare, but leading hypotheses implicate that the cholinergic pathway might play an important role in neuroinflammation and development of POD. The objective of this study was to figure out if there is an association between the development of POD and acetyl- and butyrylcholinesterase (AChE and BuChE) activities in older adult patients undergoing abdominal surgery.MethodsThe investigation was performed with a subpopulation of BioCog study patients. The BioCog project (http://www.biocog.eu) is a prospective multicenter observational study in older adult surgical patients. Patients ≥ 65 years undergoing elective surgery of at least 60 minutes who scored more than 23 points in the Mini-Mental-State-Examination were included. POD was assessed twice a day on seven consecutive days after the surgery, using the test instruments Nursing Delirium Screening Scale (Nu-Desc) and Confusion Assessment Method (CAM and CAM-ICU) and a patient chart review. Pre- and postoperative blood cholinesterase activities were measured with a photometric rapid-point-of-care-testing. The association between cholinesterase activities and POD was analyzed in a subpopulation of abdominal surgical patients using multivariable logistic regression analysis adjusting for confounders.ResultsOne hundred twenty-seven patients were included for analysis (mean age 73 years, 59% female). Fifty-two patients (41%) fulfilled the criteria of POD. These patients were significantly older, had a longer time of surgery and anesthesia and achieved higher comorbidity scores compared to patients without POD. After adjusting for age, duration of surgery and charlson comorbity index, we found an association between pre- and postoperative AChE activity (U/gHb) and the development of POD (Odds ratio (OR), [95% confidence interval (CI)], preoperative 0.95 [0.89–1.00], postoperative 0.94 [0.89–1.00]).ConclusionsWe found an association between POD and AChE activity and provided new information considering patients with abdominal surgery. Future analyses should examine course dynamics of postoperative cholinesterase activities in order to clarify interactions between the cholinergic system and pathophysiological mechanisms leading to POD.Trial registrationClinicalTrials.gov: NCT02265263. More... »

PAGES

293

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12871-022-01826-y

DOI

http://dx.doi.org/10.1186/s12871-022-01826-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1151083867

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/36114455


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    "description": "BackgroundPostoperative delirium (POD) is a frequent complication after surgery. Older adult patients undergoing abdominal surgery are at higher risk for developing POD. Studies on the association of cholinesterase activities and POD are rare, but leading hypotheses implicate that the cholinergic pathway might play an important role in neuroinflammation and development of POD. The objective of this study was to figure out if there is an association between the development of POD and acetyl- and butyrylcholinesterase (AChE and BuChE) activities in older adult patients undergoing abdominal surgery.MethodsThe investigation was performed with a subpopulation of BioCog study patients. The BioCog project (http://www.biocog.eu) is a prospective multicenter observational study in older adult surgical patients. Patients \u2265\u00a065\u2009years undergoing elective surgery of at least 60\u2009minutes who scored more than 23 points in the Mini-Mental-State-Examination were included. POD was assessed twice a day on seven consecutive days after the surgery, using the test instruments Nursing Delirium Screening Scale (Nu-Desc) and Confusion Assessment Method (CAM and CAM-ICU) and a patient chart review. Pre- and postoperative blood cholinesterase activities were measured with a photometric rapid-point-of-care-testing. The association between cholinesterase activities and POD was analyzed in a subpopulation of abdominal surgical patients using multivariable logistic regression analysis adjusting for confounders.ResultsOne hundred twenty-seven patients were included for analysis (mean age 73\u2009years, 59% female). Fifty-two patients (41%) fulfilled the criteria of POD. These patients were significantly older, had a longer time of surgery and anesthesia and achieved higher comorbidity scores compared to patients without POD. After adjusting for age, duration of surgery and charlson comorbity index, we found an association between pre- and postoperative AChE activity (U/gHb) and the development of POD (Odds ratio (OR), [95% confidence interval (CI)], preoperative 0.95 [0.89\u20131.00], postoperative 0.94 [0.89\u20131.00]).ConclusionsWe found an association between POD and AChE activity and provided new information considering patients with abdominal surgery. Future analyses should examine course dynamics of postoperative cholinesterase activities in order to clarify interactions between the cholinergic system and pathophysiological mechanisms leading to POD.Trial registrationClinicalTrials.gov: NCT02265263.", 
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25 schema:description BackgroundPostoperative delirium (POD) is a frequent complication after surgery. Older adult patients undergoing abdominal surgery are at higher risk for developing POD. Studies on the association of cholinesterase activities and POD are rare, but leading hypotheses implicate that the cholinergic pathway might play an important role in neuroinflammation and development of POD. The objective of this study was to figure out if there is an association between the development of POD and acetyl- and butyrylcholinesterase (AChE and BuChE) activities in older adult patients undergoing abdominal surgery.MethodsThe investigation was performed with a subpopulation of BioCog study patients. The BioCog project (http://www.biocog.eu) is a prospective multicenter observational study in older adult surgical patients. Patients ≥ 65 years undergoing elective surgery of at least 60 minutes who scored more than 23 points in the Mini-Mental-State-Examination were included. POD was assessed twice a day on seven consecutive days after the surgery, using the test instruments Nursing Delirium Screening Scale (Nu-Desc) and Confusion Assessment Method (CAM and CAM-ICU) and a patient chart review. Pre- and postoperative blood cholinesterase activities were measured with a photometric rapid-point-of-care-testing. The association between cholinesterase activities and POD was analyzed in a subpopulation of abdominal surgical patients using multivariable logistic regression analysis adjusting for confounders.ResultsOne hundred twenty-seven patients were included for analysis (mean age 73 years, 59% female). Fifty-two patients (41%) fulfilled the criteria of POD. These patients were significantly older, had a longer time of surgery and anesthesia and achieved higher comorbidity scores compared to patients without POD. After adjusting for age, duration of surgery and charlson comorbity index, we found an association between pre- and postoperative AChE activity (U/gHb) and the development of POD (Odds ratio (OR), [95% confidence interval (CI)], preoperative 0.95 [0.89–1.00], postoperative 0.94 [0.89–1.00]).ConclusionsWe found an association between POD and AChE activity and provided new information considering patients with abdominal surgery. Future analyses should examine course dynamics of postoperative cholinesterase activities in order to clarify interactions between the cholinergic system and pathophysiological mechanisms leading to POD.Trial registrationClinicalTrials.gov: NCT02265263.
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31 schema:keywords AChE activity
32 BackgroundPostoperative delirium
33 Charlson Comorbity Index
34 ConclusionsWe
35 Confusion Assessment Method
36 MethodsThe investigation
37 Mini-Mental
38 Nursing Delirium Screening Scale
39 ResultsOne hundred twenty
40 Screening Scale
41 State Examination
42 abdominal surgery
43 abdominal surgical patients
44 acetyl
45 activity
46 adult patients
47 adult surgical patients
48 age
49 analysis
50 anesthesia
51 assessment methods
52 association
53 blood cholinesterase activity
54 butyrylcholinesterase activity
55 chart review
56 cholinergic pathways
57 cholinergic system
58 cholinesterase activity
59 comorbidity score
60 complications
61 confounders
62 consecutive days
63 course dynamics
64 criteria
65 days
66 delirium
67 development
68 development of pods
69 duration
70 duration of surgery
71 dynamics
72 elective surgery
73 frequent complication
74 future analyses
75 high risk
76 higher comorbidity score
77 hundred twenty
78 hypothesis
79 important role
80 index
81 information
82 interaction
83 investigation
84 logistic regression analysis
85 long time
86 mechanism
87 method
88 minutes
89 multicenter observational study
90 multivariable logistic regression analysis
91 neuroinflammation
92 new information
93 objective
94 observational study
95 older adult patients
96 older adult surgical patients
97 order
98 pathophysiological mechanisms
99 pathway
100 patient chart review
101 patients
102 pods
103 point
104 project
105 prospective multicenter observational study
106 regression analysis
107 review
108 risk
109 role
110 scale
111 scores
112 study
113 study patients
114 subpopulations
115 surgery
116 surgical patients
117 system
118 time
119 twenties
120 years
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