Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

Abstract

Data on risk factors for non-adherence to doctors' and pharmacists' instructions to discontinue medications prior to surgery are lacking. This study aimed to identify characteristics and risk factors for such non-adherent patients. Patients and Methods: Data (including patient age, sex, prescription medications, comorbidities, presence of roommate at home, and number of days between receiving instruction and surgery) of 887 patients who used medications affecting surgery at a university hospital from April 2017 to March 2020 were retrospectively evaluated. The primary endpoint was to investigate the rate of non-adherence and to explore independent risk factors for non-adherence (with age categorized as ≥65 [versus <65] years). Secondary endpoints included analysis of limited number of departments subgroup and a sensitivity analysis (with age categorized as ≥75 [versus <75] years) to confirm the robustness of the primary endpoint results. Independent risk factors for non-adherence were identified using logistic regression analysis. Results:The non-adherence rate was 11.4% (n=101/887), median age (interquartile range) at admission was 73 (70-79) years, and proportion of male patients was 81.2% (n=82). The main analysis adjusted for age ≥65 (versus <65) years showed age as a risk factor for increased nonadherence (adjusted odds ratio: 2.1, 95% confidence interval: 1.09-4.05; p=0.027). However, analyses adjusted for departments (other than urology, gynecology, and breast surgery, with a large sex bias in hospitalized patients) and for age ≥75 (versus <75) years showed no such risk. Conclusion: Age ≥65 years was associated with a higher risk of non-adherence to medications that should be discontinued before surgery. It is important for doctors and pharmacists to ensure that patients at high risk for non-adherence are aware of the importance of adherence. Our findings may help identify patients at high risk for non-adherence to such medications.

Risk Factors for Non-Adherence to Pharmacist or Non-Pharmacist Explanations on Preoperative Medication Discontinuation: A Retrospective Japanese Study

“… 7 , 9 , 11 We also previously reported age ≥65 years as an independent risk factor for non-adherence to medications potentially affecting surgery, and the results of the subgroup analysis in this study showed similar results ( Table 3 ). 12 However, other analyses in this study did not show aged ≥65 years as a risk factor for non-adherence. ( Tables 2, 4 and S2 – S4 ).…”

“…Medications potentially affecting surgery were used as a categorical variable, with a threshold of two medications. 12 The longest discontinuation period for medications potentially affecting surgery was 14 days. Therefore, a discontinuation period of ≥15 days was considered clinically significant.…”

“…The aims of this study were to investigate whether the occupation of the individual explaining medication management was a risk factor for patient non-adherence after increasing the number of patients compared with that in our previous study 12 and identify risk factors for non-adherence after adjusting for confounding factors.…”

“…Our previous study showed that the rate of non-adherence was 11.4% depending on the final pharmacist’s explanation of medication management affecting surgery at a Japanese university hospital and that patient age of ≥65 years was a risk factor. 12 However, it had the following limitations: (i) the study included only groups of patients who received explanations from a pharmacist; thus, there were no data on occupational differences of individuals who ultimately provided the explanation to the patients; (ii) the number of patients was not large enough to adjust for all confounding factors; and (iii) there was an insufficient adjustment for confounding factors. 12 Nevertheless, a non-pharmacist may be the final healthcare provider who explains preoperative medication management.…”

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

“…A pharmaceutical assessment is conducted for patients admitted for elective surgery after pre-admission evaluation, which is throughout the whole process of ERAS. The key points of preoperative pharmaceutical care include (1) Preoperative medication education for patients; (2) The review of prescriptions based on outpatient pharmacy pre-assessment records to ensure high adherence to medication reconciliation [ 109 ]; and (3) For high-risk cases in preoperative assessment, individualized drug intervention plans are recommended to the ERAS treatment team before surgery to optimize ERAS medication treatment [ 106 , 110 ].…”