High-Risk Perioperative Medications in the Chinese Elderly Population

Abstract

Background: Inappropriate perioperative medications among elderly patients increase the risk of adverse events and undermine surgical outcomes. This study aimed to assess the prevalence of high-risk medications in elderly surgical patients and verify the effectiveness of a new-developed high-risk perioperative medications (HRPOMs) list for the elderly. Methods: A cross-sectional, single-center study was conducted at Jinshan Hospital of Fudan University. A total of 810 elderly surgical patients were included in the study. The HRPOMs list was applied to patients' data to identify the HRPOMs including chronic medications and medications related to surgery. Results: A total of 2113 HRPOMs were identified in 810 patients who fulfilled the inclusion criteria. Of these, 1067 (50.5%) involved medications related to surgery, and 982 (46.5%) involved chronic medications. The prevalence of HRPOM exposure, which was defined as at least one HRPOM was 76.3%. Patients that were 70 years or older (adjusted odds ratio [AOR] =2.118, 95% confidence interval [CI], 1.420~3.159), hospitalized over two weeks (AOR =4.192, 95% CI, 1.493~11.771), with more than 2 distinct diagnoses (AOR =3.407, 95% CI, 2.224~5.220) and with 16 or more medications during hospitalization were more likely to be exposed to HRPOMs. Patients who underwent surgeries of Grade IV were at 1.73 increased odds of HRPOM exposure compared with those who received surgeries of Grade III or lower (P=0.071). Conclusion:HRPOMs are more common in patients of 70 years or older, with 3 or more distinct diagnoses, with 16 or more medications and hospitalized for 15 days or longer. Our study showed the validity of the HRPOMs list in the perioperative medication review for the elderly and may induce further research to reveal the impact of HRPOMs upon the surgical outcomes of the elderly.

Ill‐fitting prosthesis is associated with an increased risk of elevated blood pressures

“…poorly designed/manufactured tooth-supported prosthesis (incorrectly seated prosthesis with an open margin between tooth and crown/veneer) and 2. poorly designed/manufactured implantsupported prosthesis (incorrectly installed prosthesis with the open margin between implant abutment and crown). 3,11 The definition of removable IFP includes: 1. removable denture (complete denture or removable partial denture) whose tissue surface does not fit with oral soft and hard tissues and 2. 'removable denture' immediately made of self-curing PMMA but not removable due to entering the undercut of adjacent teeth.…”

“…'removable denture' immediately made of self-curing PMMA but not removable due to entering the undercut of adjacent teeth. 11 In subgroup analysis, the IFP group was further divided into fixed IFP (which was composed of fixed IFP involving 1-2 teeth, fixed IFP involving more than 2 teeth, fixed IFP with unknown involved teeth number) and removable IFP.…”

“…Several limitations should be noticed when interpreting the findings of our study. First, the definitions used in this study were mainly taken from Chinese literature, 3,11 because IFP is more common in developing countries than in developed countries due to the imbalance of the global economy and medical level. Second, since the inherent limitation of an observational study, it is challenging to clarify the causal relationships between IFP and hypertension, 50 and some parameters were not available in all participants.…”

“…[3][4][5][6][7][8][9][10] Due to the low incidence of ill-fitting prostheses (IFP) (including removable ill-fitting dentures and fixed ill-fitting restorations) in developed countries, there are few studies on IFP and the study on the association between IFP and CVD even less, while IFP and its associated periodontal diseases and impaired oral function are prevalent in developing countries, which are related to the economic and medical level and people's health awareness. 5,11,12 If the association between IFP and CVD is established, correcting IFP is not only related to the improvement of oral health and mastication function but also related to the reduction in CVD risk. Hypertension is a type of CVD counting for a large population in China.…”