Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review

Lee, Ji Won; Li, Mengchi; Boyd, Cynthia M.; Green, Ariel R.; Szanton, Sarah L.

doi:10.1016/j.jamda.2021.11.005

Cited by 12 publications

(17 citation statements)

References 63 publications

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“…The strengths of this study are that it is one of a few studies that examined the impact of a geriatrician-led medication review in the inpatient setting. The sample size is comparable, if not larger than other deprescribing studies conducted in medical and surgical older inpatients [ 12 , 20 ]. The identification of PIMs using the Beers Criteria was completed and verified by two investigators.…”

Section: Discussionmentioning

confidence: 96%

“…In our study, medication optimisation interventions including deprescribing were delivered as part of a new proactive geriatric co-management model of care. A recent systematic review found that only a minority of studies evaluating deprescribing interventions in older adults undergoing surgery showed a difference in medication changes between the intervention and control groups, and few deprescribing interventions changed outcomes of quality of life, function, mortality and post-operative complications [ 20 ]. Yet, we observed that in the geriatrician co-managed group, 18% of patients had a least one PIM ceased/dose reduced and 73% had at least any regular medication ceased/dose reduced, demonstrating that deprescribing can be implemented in most patients during an acute surgical admission.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 96%

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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“…The most commonly implemented interventions were completely stopping the UAM (42.4%) and switching to mirabegron (27.1%) 21. Although evidence supporting preoperative deprescribing of PIM is limited, the overall effect is likely neutral to positive 22. Deprescribing interventions can be led by interdisciplinary teams, geriatricians or pharmacists.…”

Section: Anticholinergic Medicationsmentioning

confidence: 99%

Polypharmacy in older surgical patients: practical steps for managing perioperative medications

Gerlach

Kim

2023

International Anesthesiology Clinics

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“…Numerous expert‐validated criteria have been developed to assist with identifying PIMs and potentially beneficial omitted medicines 14,15 . Perioperative medication review is an opportunity for deprescribing interventions to reduce PIMs 16 . Medication review ahead of surgery can identify and deprescribe unnecessary medications and specific medications that may contribute to perioperative delirium risk.…”

Section: Importance Of Perioperative Medication Reviewmentioning

confidence: 99%

“…14,15 Perioperative medication review is an opportunity for deprescribing interventions to reduce PIMs. 16 Medication review ahead of surgery can identify and deprescribe unnecessary medications and specific medications that may contribute to perioperative delirium risk. Early review allows for the careful weaning of medication that may otherwise predispose patients to withdrawal syndromes.…”

Section: Importance Of Perioperative Medication Reviewmentioning

confidence: 99%

Perioperative medication management for older people

Johnson

Haywood

2022

Pharmacy Practice and Res

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The average age of surgical candidates is increasing with the ageing population worldwide. Major surgery in older patients is associated with a significant risk of complications due to physiologic changes occurring with ageing and individual patient factors such as frailty, polypharmacy, and multimorbidity. Periodic medication review should be part of the routine management of all older patients, with the perioperative period presenting an opportune time for this review. Regular medications may need short-term modification during the surgical period. Medications implicated in increasing risk of inducing or worsening delirium should be identified and withdrawal considered ahead of time. Perioperative commencement of medication aimed at reducing risk of other complications, including cardiovascular events, should be considered on an individual basis, analysing risks and benefits. Comprehensive medication review and careful planning through the perioperative period may enhance the prospects of recovery and reduce morbidity and mortality for older surgical patients.

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Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review

Cited by 12 publications

References 63 publications

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

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

Polypharmacy in older surgical patients: practical steps for managing perioperative medications

Perioperative medication management for older people

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