Effects of Potent Anticholinergics, Sedatives and Antipsychotics on Postoperative Mortality in Elderly Patients with Hip Fracture A Retrospective, Population-Based Study

Background: Concomitant use of several medications for somatic and mental disorders is common in elderly people and increases the risk of falls, with hip fracture being the most serious consequence. Objective: The objective of this study was to describe relationships between use of sedatives, antipsychotics or potent anticholinergics and postoperative mortality in patients with hip fractures. Methods: A retrospective analysis was conducted on population-based data collected during a 2-year period from 1999 to 2000 on 461 hip fracture surgery patients aged >= 65 years in Finland. Information on co-morbidities and intake of sedatives, antipsychotics and potent anticholinergics was obtained from the original patient records. Information on deaths was obtained from the official death statistics in Finland. Results: In men, use of potent anticholinergics was associated with excess age-adjusted mortality at 30 days, 3 months, 6 months and 3 years, but not in women at any timepoint. Use of potent anticholinergic drugs emerged as an independent predictor of excess mortality in men at 3 months and 3 years. Presence of cardiovascular disease and chronic lung disease were independent risk factors for excess mortality at 6 months and 3 years in men. In addition, chronic lung disease independently predicted excess mortality at 30 days. Conclusion: Use of potent anticholinergics should be evaluated critically after hip fracture surgery, especially in men with cardiovascular or chronic lung diseases.