Background Few studies have evaluated the prevalence of potentially inappropriate medications (PIMs) and its association with postoperative outcomes in a geriatric population in the preoperative setting. Objectives The purpose of this study was to evaluate the prevalence of PIMs in an older elective surgery population and to explore associations between PIMs and postoperative length of stay (LOS) and emergency department (ED) visits in the 90 days post hospital discharge, depending on frailty status. Methodology We performed a retrospective cohort study of older adults awaiting major elective noncardiac surgery and undergoing an evaluation in the preoperative clinic at a tertiary academic center between 2017 and 2018. We identified PIMs using MedSafer, a software tool built to improve the safety of prescribing. Frailty status was assessed using the 7-point Clinical Frailty Scale. We estimated the association between PIMs and postoperative LOS and ED visits in the 90 days post hospital discharge. Results The MedSafer software generated 394 recommendations on PIMs in 1619 medications for 252 patients. In total, 197 (78%) patients had at least one PIM. The cohort included 138 (51%) robust, 87 (32.2%) vulnerable and 45 (16.7%) frail patients. The association between PIMs and LOS was not significant for the robust and frail subgroups. For the vulnerable patients, every additional PIM increased LOS by 20% (incidence rate ratio 1.20; 95% confidence interval 0.90-1.44; p = 0.089) without reaching statistical significance. No association was found between PIMs and ED visits. Conclusion PIMs identified by the MedSafer software were prevalent. Preoperative evaluation represents an opportunity to plan deprescribing of PIMs.

No abstract

BackgroundSarcopenia and frailty are two different concepts with specific measures. Nonetheless, they share similarities. Whether one is a better predictor of postoperative adverse outcomes in older adults has not been well studied. Our main objective was to evaluate the psoas muscle index (PMI), used as a surrogate for sarcopenia, and the Clinical Frailty Scale (CFS) association with postoperative complications incidence. Our secondary objective was to evaluate the correlation between PMI and CFS in a cohort of non-cardiac surgery patients. MethodsWe conducted a prospective observational cohort study. Patients 65 years and older undergoing elective non-cardiac surgery in a tertiary academic center were included. Right and left psoas areas were measured on a CT scan at the fourth lumbar vertebra body level, and the sum was normalized for squared height (PMI). Sarcopenia was defined as PMI lowest tertile. The National Surgical Quality Improvement Program defined postoperative complications. We performed a negative binomial regression analysis to assess the association with postoperative complications and compared the model fit using the Akaike information criterion (AIC). Correlation between PMI and CFS was analyzed using the Spearman correlation.ResultsA total of 78 patients were included. Median PMI was 6.23 cm2/m2 (interquartile range (IQR): 5.29 – 7.21 cm2/m2) for women and 7.77 cm2/m2 (IQR: 6.49 – 8.55 cm2/m2) for men. In multivariate analysis, lower PMI tertile was significantly associated with an increasing number of complications (incidence rate ratio (IRR): 2.26, confidence interval (CI 95%): 1.01 – 5.56, p = 0.048) while CFS was not. AIC was lower with the PMI model compared to the CFS model. The correlation coefficient between PMI and CSF was -0.241 (p = 0.044).ConclusionsIn our cohort, PMI was a better predictor of postoperative complications than CFS. The correlation between PMI and CFS was weak. An objective measure of sarcopenia, compared to the broader concept of frailty, might be an easier way to identify patients with higher risks of complications. Trial registrationRetrospective ethics approval