Cancellations of elective surgical procedures due to inadequate management of chronic medications

Abstract

Summary What is known and objectives Inadequate management of chronic medication puts patients at risk and causes unnecessary suspension of surgical procedures. The objective of the study was to calculate the rate of cancellation of elective surgical procedures due to inadequate management of chronic medications and to analyse the underlying causes of cancellation. Methods We designed an analytic, observational, retrospective study of all elective surgical procedures performed from July to October 2017 in a tertiary hospital. The main variable was the percentage of surgeries cancelled owing to inadequate management of chronic medications. Other variables recorded included demographic characteristics, time between the preanaesthesia evaluation and surgery, drug involved, and the reason for incorrect management of the medication. Results During the study period, 5415 surgical procedures were programmed, and 793 (14.6%) were cancelled. Cancellations due to inadequate patient preparation accounted for 5.3% (42 cases), and 19 were related to incorrect medication management (2.4% of the total number of cancellations). The 19 patients, who were mostly men (73.7%), had a median age of 76 years (IQR 68‐81). The drugs involved were acenocoumarol (6), enoxaparin (4), clopidogrel (4), direct‐acting oral anticoagulants (2), acetylsalicylic acid (1), tocilizumab (1) and leflunomide (1). The reasons for drug mishandling were poor understanding of the anaesthesiology recommendations (15) and lack of a preanaesthesia evaluation (4). What is new and conclusion Inadequate management of chronic medications (2.4%) is not the most frequent reason for cancellation, although it is one of the easiest to avoid. Based on our results, starting in October 2017, the Pharmacy Department began to offer a pharmaceutical service to patients with doubts about the preoperative management of chronic medications.

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

“…Among the articles reviewed, the two most frequent years of publication were 2018 (Brown et al, 2018; Dries, 2018; Wyatt et al, 2018) and 2020 (Derseh et al, 2020; da Silva Schulz et al, 2020; Vogl et al, 2015) ( n = 3), followed by 2012 (Husted, 2012; Johansson Stark et al, 2014), 2015 (Crump et al, 2015; Liederbach et al, 2015) ( n = 2), 2011 (Papadopoulos et al, 2016), 2014 (Ayyadhah Alanazi, 2014), 2016 (McClurkin & Smith, 2016), 2017 (Pettersson et al, 2017) and 2019 (de Lorenzo‐Pinto et al, 2019). None of these articles were published in 2013 or 2021 (Figure 2).…”

“…This cut‐off point was established of based on reference manuscripts, avoiding fractional numbers. Finally, therefore, 15 articles were included in our literature review (Ayyadhah Alanazi, 2014; Brown et al, 2018; Crump et al, 2015; Derseh et al, 2020; Dries, 2018; Husted, 2012; Johansson Stark et al, 2014; Liederbach et al, 2015; de Lorenzo‐Pinto et al, 2019; McClurkin & Smith, 2016; Papadopoulos et al, 2016; Pettersson et al, 2017; da Silva Schulz et al, 2020; Vogl et al, 2015; Wyatt et al, 2018) (Table 2).…”

The impact of surgical cancellations on children, families, and the health system in an Australian paediatric tertiary referral hospital

“…6 Effective strategies to address and mitigate these will vary, and institutions need data to inform their decisions. 7 Cancelation of pediatric procedures carries many costs to children and families-as we have identified-as well as to the health system. While some cancelations may be inevitable, such as those caused by unpredictable fitness for surgery or urgent demands for hospital resources, it is crucial to identify risk factors for cancelation in order to minimize the frequency as well as the impact on families and services, particularly as there are suggestions that cancelation of children's surgeries are an increasing problem.…”

“…The reasons for and impact of surgical cancelations are complex and variable between institutions 6 . Effective strategies to address and mitigate these will vary, and institutions need data to inform their decisions 7 . Cancelation of pediatric procedures carries many costs to children and families—as we have identified—as well as to the health system.…”

The prevalence of chronic medication therapy problems and pharmacists’ interventions among hospitalized perioperative patients: a retrospective observational study

“…Half of the perioperative patients have a history of taking chronic medications [1]. Many studies have shown that inadequate preoperative management of chronic medications not only places patients at risk but also causes unnecessary delays in surgical procedures [1][2][3][4].…”