Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

Abstract

The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. Further, it will highlight preventive pharmacotherapy regimens that are correlated with improved patient preparation, especially those related to surgical site infection (SSI), venous thromboembolism (VTE), nausea and vomiting (PONV), postoperative ileus (POI), and emergence delirium (PoD) as well as less commonly encountered POCs such as acute kidney injury (AKI) and atrial fibrillation (AF). The importance of interprofessional collaboration in all periprocedural phases, focusing on medication management through shared responsibilities for drug therapy outcomes, will be emphasized. Finally, examples of collaborative care through shared mental models of drug stewardship and non-medical practice agreements to improve operative throughput, reduce operative stress, and increase patient satisfaction are illustrated.

The importance of pharmacists in modern day surgery – editorial

“…Several studies have demonstrated that interprofessional collaboration and a collaborative practice framework improve overall patient outcomes 13 . As a result, healthcare providers, particularly physicians and pharmacists, must work together to improve healthcare and overall patient outcomes.…”

Acompanhamento farmacoterapêutico da Tromboprofilaxia na unidade de terapia intensiva.

“…Levando em consideração que o acompanhamento da tromboprofilaxia é importante para o cuidado com o paciente, o estudo justifica-se pelo TEV ser predominante no ambiente hospitalar 12 , local onde pelo menos 1/3 dos internados possuem risco de desenvolver TVP 13 , bem como perigo da ocorrência de EP, a qual está associada a alta mortalidade intra-hospitalar (5-15%) 12 . Insta salientar que a profilaxia (medicamentosa ou não farmacológica) fornece diminuição de casos de TEV hospitalar 7 , tornando a doença uma causa de morte evitável 2,14 , favorecendo a redução de outros problemas associados, como o aumento de despesas hospitalares, a internação prolongada 12,15 , a síndrome pós-trombótica na TVP e a hipertensão pulmonar tromboembólica crônica na EP 7,12 .…”