Adverse Outcomes Associated With Inpatient Administration of Beers List Medications Following Total Knee Replacement

Abstract

Purpose: Beers List drugs are potentially harmful in older adults and are grouped by level of risk. Over 9000 total knee arthroplasties (TKAs) are performed each year Veterans Affairs (VA) hospitals, primarily on older adults. Minimal data on the administration of Beers List drugs following arthroplasty currently exists in the literature. Our goal was to quantify the risks of these drugs following TKA. We hypothesized that increasing doses of Beers List drugs would be associated with increased risks for readmission, reoperation, emergency department (ED) visits, and mortality. Methods: In this retrospective cohort study, data from TKAs performed in VA hospitals from 2010 to 2014 were examined, with complicated or bilateral procedures excluded. The data were obtained from the VA Corporate Data Warehouse. The outcomes examined were readmission, postoperative ED visits, reoperation on ipsilateral knee, and mortality. Beers List drugs were divided into 3 categories: medications to use with caution (Beers 0); medications to avoid in older adults (Beers 1); and medications to avoid in certain disease states (Beers 2). Beers 2 was not included in the final analysis due to an inability to verify appropriate diagnostic criteria without manual chart review. Logistic regression was performed looking at the total number of doses in the first 48 h after surgery compared to the above-mentioned outcomes. Findings: Data from 12,639 TKAs were analyzed; the mean age of the patients was 65.06 years, and 77.8% of patients received Beers List drugs while admitted. The most frequently administered Beers

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study

“…In a retrospective cohort study of total knee arthroplasties performed in US Department of Veterans Affairs hospitals, Beers List medication administration at any point during hospitalization was associated with increased 30-day readmissions and emergency room visits. 31 Beyond surgical populations, one small retrospective study found longer ICU and hospital LOS in patients with increased PIM administration in the ICU. 32 In our study, we observed that regardless of frailty or cognitive status, perioperative PIM administration was associated with a nearly 2-day increased LOS.…”

Anesthetic Practice Trends and Perceptions Toward Postoperative Delirium: A Mixed-Methods Analysis

“…While a single dose of these medications perioperatively may not increase risk of postoperative delirium, 30 continued use during hospitalization is associated with adverse postoperative complications, such as hospital readmission. 31 Results suggest that awareness of the harms of such medications has been growing. Indeed, national quality improvement initiatives have been launched with the aim of reducing the use of Beers Criteria medications, 26 and implementation trials have demonstrated reduced administration with a dedicated qualitive initiative program.…”

Anesthesia for Hip Replacement

“…Elderly patients also take various combinations of drugs (mainly anticholinergics or sedative-hypnotics) increasing the risk of pharmacological interactions with other drugs administered during the hospital admission such as sedative, analgesic, etc. Moreover, these multiple associations often induce unwanted symptoms such as fatigue, anxiety, and delirium, increasing perioperative mortality [34]. It is recommended to consider appropriate perioperative drug adjustments by systematically performing the BEERS Criteria for the evaluation of multiple preoperative therapy [35].…”