Atropine Weight and Risk of Postoperative Confusion in the Elderly

Study Overview
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Brief Summary
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The identification of a high atropine load of treatment received during hospitalization as a predictor of postoperative confusion could have various benefits: Pharmacoepidemiological: identify factors associated with postoperative confusion Clinics: by favoring treatments with a low atropine load during anesthesia, the management of patients hospitalized in orthopedics. Similarly, stopping or re-evaluating treatments with a high atropine weight for scheduled surgery is an easy step to take. Socio-economic: by reducing the costs related to the occurrence of a confusional syndrome (over-treatment, prolonged hospital stay, loss of autonomy, institutionalization of patients...). In total, the present study would improve the daily management of hospitalized patients and the practices of clinicians, by offering a decision-making aid.

Official Title
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Atropine Weight and Risk of Postoperative Confusion After Hip Fracture Surgery or Prosthetic Surgery of the Lower Limb, in the Elderly

Conditions
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Aging

Intervention / Treatment
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* Other: Data collection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admitted to the orthopedic department for surgical management of a fracture of the upper end of the femur in emergency or for the installation of a hip or knee prosthesis Patient able to understand and respond to the protocol No opposition to the collection of data of the patient or his / her designee Exclusion Criteria: Pre-existing confusion to surgery, detected by the CAM scale Serious or moderate head trauma less than three months old Removing / installing prosthesis.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Aged patients<br>Data collection of patients admitted to the orthopedic department of the University Hospital of Toulouse for surgical management of a fracture of the upper end of the femur in emergency or for the installation of a hip or knee prosthesis. | Other: Data collection<br>* The collection of data will be done by interrogation of the patient and his family / entourage and rereading of medical records<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Association between atropine load of medications on the risk of postoperative confusion | Occurrence of a postoperative confusion syndrome performed by Confusion Assessment Method (CAM) scale once a day. The CAM is a validated scale as a diagnostic scale for confusional syndrome at the patient's bedside with four parts : 1) confusion and fluctuation of symptoms, 2) inattention, 3) disorganization of thought, 4) disorder of consciousness. | up to 7 days | 
| Atropinic load of drugs | The DURAN scale is the most recent and most comprehensive atropine load evaluation scale. This scale classifies the evaluated drugs into three categories: no anticholinergic power (atropine weight = 0), low anticholinergic activity (atropine weight = 1), high atropinic power (atropine weight = 3). All drugs received by the patient during 7 days will be classified with the Duran scale. | up to 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of hospitalization | Number of days of hospitalization (days) between surgery and discharge. Association between atropinic load of drugs and duration of hospitalization will be evaluated. | Up to discharge, an average of ten days | 
| Autonomy | Description of autonomy of the patient at three months of surgery evaluated by the Activity Daily Living scale (ADL). The ADL scale evaluates activities of daily living: washing, dressing, going to the bathroom, ensuring transfers, continence and food. Each item is rated according to a level of dependence: independent (1 point), with assistance (0.5 points), unable to achieve (0 points). A total of 6 points indicates a total autonomy, and 0 a total dependency. | Month 3 | 
| Cognitive dysfunction | Appearance postoperative cognitive dysfunction by the Mini Mental State (MMS). the total score of MMS wil be collected. | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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atropinic drugs, confusion, elderly patients