Observational studyArchives of orthopaedic and trauma surgery2025
Anticholinergic burden and postoperative mortality in older adults with hip fracture: a real-world observational study.
Observational study in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
introductionAnticholinergic burden is common in older adults and has been associated with adverse outcomes such as cognitive impairment and functional decline. Its long-term effect on surgical recovery after hip fracture, however, remains unclear. This study aimed to evaluate the association between anticholinergic burden at hospital admission and postoperative outcomes, including mortality, functional recovery, and readmissions, in older adults undergoing hip fracture surgery.
methodsThis retrospective observational study included patients aged ≥ 70 years who underwent surgical treatment for hip fracture between January 2017 and December 2018. Anticholinergic burden was quantified using the Anticholinergic Cognitive Burden (ACB) scale based on pre-admission medications, and patients were classified into two groups: low burden (ACB 0–2) and high burden (ACB ≥ 3). The primary outcome was 5-year all-cause mortality. Secondary outcomes included in-hospital complications, readmissions, and ambulatory recovery at 30 days and 6 months.
results646 patients were included in the study; 206 (31.9%) had a high anticholinergic burden. Compared to those with low burden, high burden patients had greater comorbidity (Charlson Index 3.1 vs. 2.6, p = 0.005), poorer baseline function (Barthel Index 65.7 vs. 79.1, p < 0.001), and more frequent severe polypharmacy (≥ 10 drugs: 45.1% vs. 7.4%, p < 0.001). They experienced more in-hospital complications (56.8% vs. 47.5%, p = 0.028), and major complications (56.3% vs. 44.8%, p = 0.006). Functional recovery was significantly reduced, with fewer patients ambulatory at 30 days (59.7% vs. 72.8%, p = 0.002) and at 6 months (71.5% vs. 83.0%, p = 0.002). Readmissions were more frequent (2.2 vs. 1.7 per patient, p = 0.015). Five-year mortality was higher in the high burden group (71.8% vs. 47.0%, p < 0.001), with an adjusted HR of 1.56 (95% CI: 1.22–2.00). Median follow-up time was 1.425 days (IQR 450–1825).
conclusionsHigh anticholinergic burden at admission is independently associated with increased long-term mortality, complications, readmissions, and poorer functional recovery after hip fracture surgery in older adults.
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