Anticholinergic burden and polypharmacy in hospitalized urology patients: Prevalence and clinical implications

ABSTRACT Background: The increasing prevalence of polypharmacy and cumulative anticholinergic burden (ACB) in hospitalized patients represents a major concern for drug safety and pharmacological risk management. This study evaluated the prevalence and predictors of polypharmacy and ACB in urology inpatient population, with a focus on pharmacological classification of anticholinergic exposure. Materials and Methods: A retrospective cohort study was conducted among 500 consecutive patients admitted to a tertiary urology department between September 2024 and March 2025. Data were extracted from the electronic medical records, including demographics, clinical diagnoses, and prescribed medications. Polypharmacy was defined as ≥5 concurrent medications. Anticholinergic burden was assessed using the Anticholinergic Cognitive Burden (ACB) Scale, with scores ≥3 considered high risk. Results: The cohort had a mean age of 61.7 ± 14.2 years and was predominantly male (81.6%). Polypharmacy was observed in 40.6% of the patients, with significantly higher prevalence in those ≥50 years (47.1% vs. 9.3%; odds ratio = 6.88, 95% confidence interval: 4.09–18.43). Anticholinergic medications were prescribed to 71.4% of the patients, with 25.6% classified as high-risk (ACB ≥3). Pharmacological subgroup analysis revealed frequent exposure to cardiovascular, psychotropic, neurological, and urological agents with anticholinergic properties. Older age was associated with higher ACB scores ( P = 0.043). No significant sex differences were observed in the prevalence of polypharmacy ( P = 0.06) or ACB burden ( P > 0.05). Conclusions: Urology inpatients, particularly older adults, demonstrate high rates of polypharmacy and pharmacologically significant anticholinergic exposure. These findings underscore the importance of pharmacological vigilance, rational prescribing, and deprescribing strategies to mitigate drug-related adverse outcomes in hospitalized population.