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P OSTER
A BSTRACTS
ent effect of cardiopulmonary comorbidities on VTE. Secondarily, we
analyzed functional status expressed in a summary physical component
score (PCS) in a subset of patients for whom it was available.
Results: There were 24,051 THR and TKR surgeries performed
at the VA during the study period. COPD predicted a 24% increase in
VTE (OR=1.24, 95% CI 1.06-1.45). Low values of PCS, which was
available for 3256 patients, demonstrated a trend of increased risk of
VTE (lowest quartile OR =1.65, 95% CI 0.96-2.85 compared with
highest quartile).
Conclusions: COPD predicted a small increase in VTE whereas
low functional status appeared to increase the odds of VTE substantially.
Our findings suggest that cardiopulmonary comorbidities
should not be factored into decisions about prophylaxis but that functional
status probably should be assessed. More definitive conclusions
about the role of these comorbidities and functional status are
limited by typical constraints of administrative data analysis.
B168
Psychoactive Medications as Predictors of Post-operative Delirium
in Hip Fracture Patients.
A. L. Gruber-Baldini, 1 E. R. Marcantonio, 2 D. Orwig, 1 E. Barr, 1
N. Ma, 1 M. Terrin, 1 J. Magaziner, 1 J. L. Carson. 3 1. Epidemiology &
Public Health, University of Maryland School of Medicine, Baltimore,
MD; 2. Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, Boston, MA; 3. . Division of General
Internal Medicine, UMDNJ-Robert Wood Johnson Medical School,
New Brunswick, NJ.
Supported By: Supported in part by grants from the National Heart,
Lung, & Blood Institute: R01 HL085706, U01 HL073958 and U01
HL074815, by a National Institute on Aging training grant: T32
AG00262, and by funds from the Claude D. Pepper Older
Americans Independence Center, National Institute on Aging, P30
AG028747.Dr. Marcantonio is a recipient of a Mid-Career
Investigator Award in Patient-Oriented Research (K24 AG035075)
from the National Institute on Aging.
Delirium is common after hip fracture and is associated with
poor short- and long-term outcomes. Previous research suggests that
psychoactive medications may increase risk of delirium, and it is hypothesized
that anticholinergic medications may also increase delirium.
In this paper we examine the association of psychoactive medications
on delirium severity in 131 patients from the Transfusion
Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing
Surgical Hip Fracture Repair(FOCUS) Cognitive Ancillary
Study, a randomized clinical trial examining the impact of blood
transfusion strategy on delirium. Medication administration records
24 hours before initial post-surgery assessment were coded by drug
class, and also using 3 scales which summarize anticholinergic effects:
Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale
(ARS), and Anticholinergic Cognitive Burden Scale (ACBS). Delirium
severity was measured 1-5 days post-surgery (Mean=1.8, SD=0.8)
using the Memorial Delirium Assessment Scale (MDAS) and delirium
presence using Confusion Assessment Method Diagnostic Algorithm
(CAM). Average age was 81.8 (SD=9.0), 74.1% female, and
90.8% white. The average number of psychoactive medications administered
24-hours before initial post-operative assessment was 1.7
(SD=1.8, range 0-8). Mean MDAS 7.1 (SD=5.3) and 29.8% CAM
delirium. Percentage on medications by class: antipsychotics 2.3%,
antidepressants 13.7%, opiates 0.8%, antihistamines 6.1%, analgesics
62.6%, sedative-hypnotics 10.7%, anticholinergics 5.3%, ADS 57.3%,
ARS 22.1%, ACBS 58.0%. The simple count of anticholinergic drugs
was significantly associated with MDAS delirium severity (r=0.22,
p=0.01), but none of the more complicated anticholinergic scales (all
r0.10). Number of opiates, antihistamines, analgesics, antidepressants,
and sedative-hypnotics was not associated with delirium
severity or presence. Greater antipsychotic medication use was associated
with worse MDAS delirium severity (r=0.18, p=0.03). Simple
counts of antipsychotics and anticholinergics in prior 24 hours were
associated with delirium after hip fracture surgery.
B169
Complications Following Cochlear Implantation in Older Adults.
D. M. Clarrett, 1 L. Li, 2 F. R. Lin. 3 1. University of Cincinnati College
of Medicine, Cincinnati, OH; 2. The Johns Hopkins Center on Aging
and Health, Baltimore, MD; 3. Otolaryngology-Head and Neck
Surgery, Johns Hopkins Hospital, Baltimore, MD.
Supported By: Medical Student Training in Aging Research
(MSTAR) program at Johns Hopkins University
Background: Cochlear implantation (CI) is a hearing rehabilitative
option for individuals with severe-to-profound sensorineural
hearing loss. However, older adults with hearing loss are infrequently
referred for CI, in part due to concerns about surgical risks and the
potential for poor recovery among older adults. The objective of this
study was to analyze the postoperative complications associated with
CI surgery in a large, consecutive case series of older adults (≥60
years) undergoing CI. Methods:The Johns Hopkins Listening Center,
the largest provider of cochlear implants in North America, maintains
a prospective database of all patients receiving cochlear implants at
Johns Hopkins. We queried this database to ascertain all individuals
≥60 years who underwent a first CI from 1999-2011. We then performed
a retrospective chart review of the electronic patient record
system at Johns Hopkins to abstract data on post-operative follow-up
and complications. Abstracted data were coded and validated by randomly
sampling 15% of the sample for repeat data abstraction. Statistical
analyses comparing observed frequencies were performed
using goodness-of-fit Fisher exact tests. Results: From 1999-2011, 445
individuals ≥60 years received a first cochlear implant at Johns Hopkins.
The mean age at implantation was 72.7 years (range 60-94.9
years) and the median duration of follow-up was 4.8 years (range 0.1-
12.5 years). There were a total of 42 minor complications (surgical
site infection, balance problems, delayed transient facial weakness, facial
nerve stimulation) in 41 patients (9.2%) and 36 major complications
(device failure, skin flap dehiscence, surgical device removal) in
21 patients (4.7%). There were no cases of meningitis or postoperative
facial paralysis. Seventeen patients (3.8%) required surgical device
removal. Complication rates did not differ between individuals