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4CPS-002 Anticholinergic burden in constipated patient admitted to an emergency department
  1. A Plaza Diaz1,
  2. J Ruiz Ramos1,
  3. A Juanes Borrego1,
  4. M Blazquez Andion2,
  5. L Lopez Vinardell1,
  6. MA Mangues Bafalluy1
  1. 1Hospital Sant Pau, Pharmacy, Barcelona, Spain
  2. 2Hospital Sant Pau, Emergency Department, Barcelona, Spain


Background and importance Intestinal obstruction and constipation are frequent causes of attendance at the emergency services. Multiple studies have linked a high anticholinergic burden with constipation in elderly patients. However, its impact on patients attending the emergency department has not yet been clearly established.

Aim and objectives To evaluate the anticholinergic burden in patients who come to the emergency services for constipation, as well as its impact on re-attendance to these units.

Material and methods This was a retrospective observational study. Patients who consulted the emergency department for constipation or intestinal subocclusion were included (September 2018–June 2019). Drugs were collected from the electronic prescription. The anticholinergic burden of the medication was calculated using the anticholinergic burden index scale.1

A multivariate analysis was performed, including in the model parameters with a value of p <0.2 in the previous univariate analysis. The impact of continuous laxative treatment at discharge on the risk of re-attendance was evaluated. Statistical analysis was carried out using Stata V.2.0.

Results A total of 104 patients were included (mean age 77.1 (±14.6) years)): 47 patients (56.6%) were classified as having a high cholinergic burden, 30 (36.1%) an intermediate burden and 6 (7.2%) a low burden.

In the univariate analysis, the variables associated with readmission at 30 days were age >80 years, women, diabetes, residence destination, dementia and high cholinergic burden.

In the multivariate analysis, age >80 years (0.34 (0.12–0.97)), a high anticholinergic burden (4.21 (1.07–16.5)) and dementia (3.26 (1.11–9.50)) were associated with readmission after 30 days.

Laxative prescription at discharge in the high burden group patients was not associated with a reduction in re-attendance (OR (95% CI) 0.86 (0.48–3.27)). In the intermediate burden group, a reduction in income was observed (OR (95% CI) 0.13 (0.015–0.99)).

Conclusion and relevance A high anticholinergic burden at discharge from the emergency department in elderly patients who consult for constipation was closely related to re-attendance at 30 days. Hence these patients must be considered high risk and specific interventions established.

References and/or acknowledgements 1. Hilmer SN. Calculating and using the drug burden index score in research and practice. Expert Rev Clin Pharmacol 2018;11:1053–5.

No conflict of interest.

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