Association of Preoperative Anticholinergic Medication Exposure With Postoperative Healthcare Resource Use and Outcomes

McIsaac, Daniel I.; Wong, Coralie A; Diep, Deric; Walraven, Carl van

doi:10.1097/sla.0000000000002765

Cited by 12 publications

(8 citation statements)

References 31 publications

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“…We found that frail patients had significantly higher rates of DBI and hyperpolypharmacy on discharge. Medication utilization has not been well‐studied in surgical populations but is important as it is linked to other adverse outcomes including geriatric syndromes 37,38 . Moreover, deprescribing interventions can be undertaken safely in the acute hospital setting to reduce the burden of potentially inappropriate medications, 39 although this needs to be confirmed in older hospitalized surgical patients.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Thillainadesan

Mudge

Aitken

et al. 2020

J American Geriatrics Society

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Background Frailty in older vascular surgery patients is associated with increased mortality, hospital stay, and morbidity. The association of frailty with hospital‐acquired geriatric syndromes such as delirium and functional decline has not been well studied. Objectives To investigate the association between frailty and hospital‐acquired geriatric syndromes in older hospitalized vascular surgery patients, and to evaluate the prognostic performance of the frailty index (FI) and the Clinical Frailty Scale (CFS) for delirium and functional decline. Design Prospective cohort study. Setting Acute care academic hospital. Participants Patients aged 65 years or more admitted to a tertiary vascular surgery unit (N=150). Measurements Frailty was assessed using the FI and CFS. The adjusted association of frailty status with delirium and functional decline was assessed using logistic regression analysis. The prognostic performance of FI and CFS was determined by assessing C‐statistic and positive and negative predictive values (PPV and NPV). Results Of 150 participants, FI identified 34 (23%) and CFS identified 45 (30%) as frail. Frailty was an independent predictor of delirium (FI adjusted odds ratio, odds ratio (OR) = 5.66, 95% confidence interval (CI) = 1.53–21.03; CFS adjusted OR = 4.07, 95% CI = 1.14–14.50), but not functional decline. FI and CFS showed acceptable prognostic performance for delirium (C‐statistic 0.74), but not functional decline (C‐statistic 0.63–0.64). For both outcomes, the FI and CFS had high NPV (86–96%), and low PPV (22–29%). Conclusion Frail older vascular surgery patients are more likely to develop hospital‐acquired geriatric syndromes. The FI and CFS have acceptable prognostic performance for predicting delirium but not all individuals who are identified as frail develop delirium. Ongoing research is needed to identify interventions that improve outcomes in patients who screen positive for frailty.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Thillainadesan

Mudge

Aitken

et al. 2020

J American Geriatrics Society

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“…Unusual symptoms might result in more prescriptions and, indeed, probably more PIMs. This is the so-called prescribing cascade, whereby one medication is added to treat the symptom that arises from another medication (e.g., an antihypertensive therapy to treat hypertension from an NSAID) [24]. Having more PIMs may be a measure of underlying geriatric susceptibility [25].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Medication Use in Older Adults in the Preoperative Period: A Retrospective Study of a Noncardiac Surgery Cohort

Forget

McDonald

Shema

et al. 2020

Drugs - Real World Outcomes

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Background Few studies have evaluated the prevalence of potentially inappropriate medications (PIMs) and its association with postoperative outcomes in a geriatric population in the preoperative setting. Objectives The purpose of this study was to evaluate the prevalence of PIMs in an older elective surgery population and to explore associations between PIMs and postoperative length of stay (LOS) and emergency department (ED) visits in the 90 days post hospital discharge, depending on frailty status. Methodology We performed a retrospective cohort study of older adults awaiting major elective noncardiac surgery and undergoing an evaluation in the preoperative clinic at a tertiary academic center between 2017 and 2018. We identified PIMs using MedSafer, a software tool built to improve the safety of prescribing. Frailty status was assessed using the 7-point Clinical Frailty Scale. We estimated the association between PIMs and postoperative LOS and ED visits in the 90 days post hospital discharge. Results The MedSafer software generated 394 recommendations on PIMs in 1619 medications for 252 patients. In total, 197 (78%) patients had at least one PIM. The cohort included 138 (51%) robust, 87 (32.2%) vulnerable and 45 (16.7%) frail patients. The association between PIMs and LOS was not significant for the robust and frail subgroups. For the vulnerable patients, every additional PIM increased LOS by 20% (incidence rate ratio 1.20; 95% confidence interval 0.90-1.44; p = 0.089) without reaching statistical significance. No association was found between PIMs and ED visits. Conclusion PIMs identified by the MedSafer software were prevalent. Preoperative evaluation represents an opportunity to plan deprescribing of PIMs.

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“…Certain drugs are more frequently associated with adverse drug reactions, including digoxin, antidiabetic agents and non-steroidal anti-inflammatory drugs [ 26 ]. Specific classes of PIMs have also been associated with worse outcomes in hospitalised surgical patients [ 27 , 28 ]. The authors of the Beers criteria remind clinicians that the medications identified using the criteria are only potentially inappropriate, not always inappropriate [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

Wang

James²,

Hilmer³

et al. 2023

Drugs Aging

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Background Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. Objective We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. Methods We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥ 65 years with an expected length of stay of ≥ 2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. Results There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0–85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0–84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients ( p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). Conclusions Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management. Supplementary Information The online version contain...

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Association of Preoperative Anticholinergic Medication Exposure With Postoperative Healthcare Resource Use and Outcomes

Abstract: Increasing ARS scores were associated with increased LOS, decreased survival, higher rates of institutional discharge and readmission, and higher costs of care. Perioperative interventional research to reduce the anticholinergic exposure in older surgical patients is likely warranted.

Cited by 12 publications

References 31 publications

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

The Prognostic Performance of Frailty for Delirium and Functional Decline in Vascular Surgery Patients

Potentially Inappropriate Medication Use in Older Adults in the Preoperative Period: A Retrospective Study of a Noncardiac Surgery Cohort

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

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