Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

Abstract

Background The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). Conclusion Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval. Registration number NCT04805151 (http://clinicaltrials.gov).

The association of degree of polypharmacy before and after among hospitalised internal medicine patients and clinical outcomes: a retrospective, population-based cohort study

“…Contrary to the findings of numerous studies, 34 49–51 we did not find a link between the polypharmacy burden and clinical outcomes like mortality, longer hospital stay and re-admission rate. This may be because patients in all three medication use categories have similar burden of comorbidity (Elixhauser Comorbidity Score (39%>8) and risk of frailty (medium or high hospital frailty risk index classification)), which likely drives the observed difference in these outcomes in studies where there is a good correlation between comorbidity burden and polypharmacy.…”

“… 34 The internal medicine patients were also older (73 vs 55 years). 34 Additionally, the results reveal that in the cohort, patients with a higher level of polypharmacy burden were more likely to be male. Previous evidence has been conflicting.…”

“… 7 Similarly, a study focusing on surgical inpatients reported a prevalence of polypharmacy at 32.2% and hyperpolypharmacy at 23.5%. 34 This was anticipated as the internal medicine patients have higher comorbidity and frailty indices compared with the surgical population, which contains a substantial number of patients undergoing elective surgery. 34 The internal medicine patients were also older (73 vs 55 years).…”

“… 34 This was anticipated as the internal medicine patients have higher comorbidity and frailty indices compared with the surgical population, which contains a substantial number of patients undergoing elective surgery. 34 The internal medicine patients were also older (73 vs 55 years). 34 Additionally, the results reveal that in the cohort, patients with a higher level of polypharmacy burden were more likely to be male.…”

Polypharmacy: Benefit or harm?

“…Sjúkrahúsdvöl var lengri og endurinnlagnir fleiri hjá þeim sem voru á fjöllyfjameðferð. 3 Það er flókið að greina aukaverkanir tengdar fjöllyfjameðferð aldraðra fjölveikra einstaklinga. Landspítali tók þátt í Evrópskri fjölsetrarannsókn sem sýndi að nýgengi aukaverkana lyfja var nálaegt 25% í bráðainnlögnum aldraðra á fjöllyfjameðferð.…”