- Scopolamine is an anticholinergic drug frequently used to prevent postoperative nausea and vomiting (PONV). While effective for this indication, scopolamine has several potential side effects, including sedation, urinary retention, tachycardia, and delirium, that may be of particular concern in elderly patients.
- This retrospective cohort study evaluated whether patients who received scopolamine within 24 hours of surgery were more likely than nonusers to experience adverse events (including in-hospital mortality, delirium, pneumonia, urinary retention, and readmission) during the seven-day period following surgery.
- The authors used the TriNetX Analytics Network database of patients undergoing major surgery to identify over 400,000 perioperative patient encounters between January 2009 and March 2018. Subjects were divided into cohorts by age (20-29, 30-39, 40-49, 50-59, 60-69, and 70+), and 1:1 propensity score matching was used to pair scopolamine users and nonusers and reduce the risk of bias.
- The authors found that patients who received scopolamine were more likely to experience in-hospital adverse events during the postoperative period, including increased rates of postoperative mortality, delirium, pneumonia, new need for antipsychotic use, urinary retention, and readmission.
- While scopolamine users across all age groups were more likely than nonusers to experience adverse events, the authors noted that the rate and magnitude of complications increased with age. For example, mortality rates for scopolamine users in the 60-69 and 70+ age groups were three and four times higher than their nonuser counterparts, respectively.
- The authors concluded that clinicians should carefully evaluate the risks and benefits of scopolamine use for each individual patient, particularly elderly patients, and suggested that scopolamine may be best suited for post-discharge PONV after ambulatory surgeries.
Summary of "A comprehensive analysis of in-hospital adverse events after scopolamine administration: insights from a retrospective cohort study using a large nationwide inpatient database"
Summary published February 10, 2025
