Anti-cholinergic burden and patient related clinical outcomes in an emergency general surgical setting

Asian J Surg. 2019 Apr;42(4):527-534. doi: 10.1016/j.asjsur.2018.10.005. Epub 2018 Nov 10.


Background/objective: The impact of medications with anti-cholinergic properties on morbidity and mortality of unselected adult patients admitted to the emergency general surgical setting has not been investigated.

Methods: All cases were identified prospectively from unselected adult patients admitted to the emergency general surgical ward between May to July 2016 in a UK centre with a catchment population circa 500,000. Prescribed medication lists were ascertained from case notes and electronic medical records. Anti-Cholinergic Burden (ACB) was calculated from medication lists. Patients were categorised into three groups based on ACB; none (ACB score of 0); moderate (up to ACB score of two); high (ACB score more than two). The effect of increasing ACB on selected outcomes of 30- and 90-day mortality, hospital readmission within 30-days of discharge and increased length of hospital stay were examined using multivariable logistic regression models.

Results: The 452 patients had a mean age (SD) of 51.7 (±20.6) years, 273 (60.4%) patients had no ACB burden, 106 (23.5%) had a ACB burden of up to two; and 73 (16.2%) had an ACB burden of > 2. Multivariable analyses showed no association between high ACB burden and 90-day (fully adjusted odds ratio [OR] 0.56 (95%CI 0.12-2.85); P = 0.48) and 30-day mortality (fully adjusted OR = 0.75 (95%CI 0.05-11.04); P = 0.84). A significant association was observed between moderate ACB burden and 30-day hospital readmission (fully adjusted OR = 2.01 (95%CI 1.09-3.71); P = 0.03).

Conclusions: Anti-cholinergic burden may be linked to hospital readmission in adults admitted to an emergency general surgical ward.

Keywords: 30-Day mortality; 30-Day readmission; 90-Day mortality; Anti-Cholinergic Burden; Change in destination; Emergency surgery; Length of hospital stay.

MeSH terms

  • Adult
  • Aged
  • Cholinergic Antagonists / administration & dosage
  • Cholinergic Antagonists / adverse effects*
  • Emergency Medical Services*
  • Female
  • General Surgery*
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Prospective Studies
  • Surgical Procedures, Operative* / mortality
  • Time Factors
  • Treatment Outcome


  • Cholinergic Antagonists