Perioperative medicine & outcomes
Anticholinergic Drug Burden and Postoperative Delirium: A Systematic Review and Meta-Analysis
Pooled result · ADB scores, patients with POD vs without PODResult — go to the resultSMD 0.31 95% CI 0.20–0.43Authors' conclusion
Higher ADB is significantly associated with higher odds of POD, with a graded increase in risk across burden levels. Baseline cognitive impairment appears to amplify this association. These findings support preoperative ADB assessment and medication optimization in vulnerable surgical patients, while highlighting the need for prospective head-to-head comparisons of anticholinergic burden scales.
Study context
- Population
- Adult surgical patients with anticholinergic drug burden assessed using validated scales and postoperative delirium outcomes reportedTen reports from nine independent cohorts
- Participants
- 10,457 patients
- Comparison
- Anticholinergic drug burden (ADB) scores and postoperative delirium (POD) risk in adult surgical patients
- Outcome
- ADB scores, patients with POD vs without POD
Methodological detailsrandom-effects models, prespecified subgroup and sensitivity analyses, NOS risk of bias, GRADE certainty of evidence
- Random-effects models
- Prespecified subgroup and sensitivity analyses
- NOS risk of bias
- GRADE certainty of evidence
Pooled result
As reported in the abstract
SMD
0.31
95% CI 0.20–0.43
POD vs without POD
SMD 0.31 (95% CI 0.20–0.43)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| Odds of POD per one-point increase in continuous ADB22% higher odds of POD | 1.22 (1.09–1.37) | |
| 0.512Odds ratio (log scale) |
POD risk by burden level
- Both low-to-moderate and high burden were associated with increased POD risk
Scale-specific analyses
- Association significant for ACB
Studies excluding patients with cognitive impairment (subgroup)
- Association attenuated
Methodological quality and certainty of evidence
- Methodological quality ranged from moderate to high
- Certainty of evidence was low
Original publication
Anticholinergic Drug Burden and Postoperative Delirium: A Systematic Review and Meta-Analysis. Anaesth Crit Care Pain Med. Published 27 October 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →