دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.
المؤلفون: Burfeind KG; From the Department of Anesthesiology and Perioperative Medicine., Zarnegarnia Y; From the Department of Anesthesiology and Perioperative Medicine., Tekkali P; From the Department of Anesthesiology and Perioperative Medicine., O'Glasser AY; From the Department of Anesthesiology and Perioperative Medicine.; Department of Medicine, Division of Hospital Medicine., Quinn JF; Department of Neurology, Oregon Health & Science University, Portland, Oregon., Schenning KJ; From the Department of Anesthesiology and Perioperative Medicine.
المصدر: Anesthesia and analgesia [Anesth Analg] 2022 Nov 01; Vol. 135 (5), pp. 1048-1056. Date of Electronic Publication: 2022 Aug 19.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1310650 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-7598 (Electronic) Linking ISSN: 00032999 NLM ISO Abbreviation: Anesth Analg Subsets: MEDLINE
أسماء مطبوعة: Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins
Original Publication: Cleveland, International Anesthesia Research Society.
مواضيع طبية MeSH: Potentially Inappropriate Medication List* , Frailty*, Humans ; Aged ; Retrospective Studies ; Patient Discharge ; Hospitalization
مستخلص: Background: The American Geriatrics Society (AGS) Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years of age. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients who were frail or cognitively impaired.
Methods: We performed a retrospective cohort study of patients ≥65 years of age who underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0 to 2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score of ≥8. Patients were divided into 2 groups depending on whether they received at least 1 PIM (PIM+), based on the 2019 AGS Beers Criteria, in the perioperative period or none (PIM-). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA physical status, and intensive care unit (ICU) admission.
Results: Of the 1627 included patients (mean age, 73.7 years), 69.3% (n = 1128) received at least 1 PIM. A total of 12.7% of patients were frail, and 11.1% of patients were cognitively impaired; 64% of the frail patients and 58% of the cognitively impaired patients received at least 1 PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM-, 3.56 ± 5.2 vs PIM+, 4.93 ± 5.66 days; P < .001; 95% confidence interval [CI], 0.360-0.546). Frail patients who received PIMs had an average length of stay (LOS) that was nearly 2 days longer than frail patients who did not receive PIMs (PIM-, 4.48 ± 5.04 vs PIM+, 6.33 ± 5.89 days; P = .02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+, 26.3% vs PIM-, 28.7%; P = .87; 95% CI, -0.046 to 0.054).
Conclusions: Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital LOS, particularly in frail patients. There was no association found between PIM administration and discharge disposition.
Competing Interests: The authors declare no conflicts of interest.
(Copyright © 2022 International Anesthesia Research Society.)
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معلومات مُعتمدة: R03 AG056462 United States AG NIA NIH HHS
تواريخ الأحداث: Date Created: 20220820 Date Completed: 20221025 Latest Revision: 20231102
رمز التحديث: 20231102
مُعرف محوري في PubMed: PMC9588532
DOI: 10.1213/ANE.0000000000006185
PMID: 35986676
قاعدة البيانات: MEDLINE
الوصف
تدمد:1526-7598
DOI:10.1213/ANE.0000000000006185