Stopping and restarting medications in the perioperative period

Cygan, Ralph; Waitzkin, Howard

doi:10.1007/bf02596452

Cited by 26 publications

(7 citation statements)

References 71 publications

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“…However, we found that nonresumption of an ACE‐I during the first 2 weeks after surgery is independently associated with increased 30‐day mortality. Our study is one of the first to examine the patterns and risks of postoperative ACE‐I management across a large and varied surgical population …”

Section: Discussionmentioning

confidence: 99%

“…Our study is one of the first to examine the patterns and risks of postoperative ACE-I management across a large and varied surgical population. 11,17 The lack of inpatient and outpatient ACE-I prescription use by postoperative day 14 across multiple surgery classes suggests that surgical patients may be prone to short-term nonresumption of an ACE-I. Our intention in using a 14-day window to evaluate restarting strategies was to account for immediate postoperative management.…”

Section: Discussionmentioning

confidence: 99%

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Thirty‐day mortality risk associated with the postoperative nonresumption of angiotensin‐converting enzyme inhibitors: A retrospective study of the veterans affairs healthcare system

Mudumbai

Takemoto

Cason

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Angiotensin‐converting enzyme inhibitors (ACE‐Is) are a widely used class of cardiovascular medication. However, limited data exist on the risks of postoperative nonresumption of an ACE‐I. OBJECTIVE To evaluate the factors and 30‐day mortality risks associated with the postoperative nonresumption of an ACE‐I. DESIGN A retrospective cohort study. SETTING Veterans Affairs (VA) Healthcare System. PATIENTS A total of 294,505 admissions in 240,978 patients with multiple preoperative prescription refills (>3) for an ACE‐I who underwent inpatient surgery from calendar years 1999 to 2012. INTERVENTION None. MEASUREMENTS We classified surgical admissions based upon the timing of postoperative resumption of an ACE‐I prescription from the day of surgery through postoperative days 0 to 14 and 15 to 30, and collected 30‐day mortality data. We evaluated the relationship between 30‐day mortality and the nonresumption of an ACE‐I from postoperative day 0 to 14 using proportional hazard regression models, adjusting for patient‐ and hospital‐level risk factors. Sensitivity analyses were conducted using more homogeneous subpopulations and propensity score models. RESULTS Twenty‐five percent of our cohort did not resume an ACE‐I during the 14 days following surgery. Nonresumption of an ACE‐I within postoperative day 0 to 14 was independently associated with increased 30‐day mortality (hazard ratio: 3.44; 95% confidence interval: 3.30‐3.60; P < 0.001) compared to the restart group. Sensitivity analyses maintained this relationship. CONCLUSIONS Nonresumption of an ACE‐I is common after major inpatient surgery in the large VA Health Care System. Restarting of an ACE‐I within postoperative day 0 to 14 is, however, associated with decreased 30‐day mortality. Careful attention to the issue of timely reinstitution of chronic medications such as an ACE‐I is indicated. Journal of Hospital Medicine 2014;9:289–296. 2014 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thirty‐day mortality risk associated with the postoperative nonresumption of angiotensin‐converting enzyme inhibitors: A retrospective study of the veterans affairs healthcare system

Mudumbai

Takemoto

Cason

et al. 2014

Journal of Hospital Medicine

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“…Patients who take anticoagulants may undergo a sinus graft procedure, but only after authorization of the patient's treating physician to verify coagulation status [31,32]. Discontinuing anticoagulants is no longer considered absolutely necessary if the INR value is within an acceptable range.…”

Section: Anticoagulant Therapymentioning

confidence: 99%

Sinus Bone Graft - Where and Where Not to be? - A Review

Patil¹,

Ml²,

Thakare³

2016

Periodon Prosthodon

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“…Hypolipidemic agents, with the exception of statins, should be discontinued at least 24 h prior to surgery as risks of myopathy and rhabdomyolysis associated with these agents increase with surgery. While these risks are also associated with statin therapy, perioperative benefits, such as reduction in cardiovascular events in the early postoperative period after vascular surgery in patients with coronary disease or coronary equivalents, have been suggested from mostly large observational studies [28–30]. Studies do not provide a clear guidance on timing of the initiation of statins prior to surgery; however, a reasonable recommendation is to begin at least 1 month prior to planned surgery in order to assess for potential adverse effects and to reach target low-density lipoprotein-cholesterol levels as recommended for patients with coronary disease or coronary equivalents.…”

Section: Cardiovascular System: Physiologic Changes and Pharmacologic Omentioning

confidence: 99%

“…Angiotensin-converting enzyme inhibitors and Ang II-receptor blockers have the potential to cause severe and prolonged intraoperative hypotension in the elderly, particularly with induction of anesthesia. Careful volume and potassium replacement is important in patients on chronic diuretics in order to minimize the risk of cardiac arrhythmias [30]. Calcium-channel blockers have been associated with an increased incidence of postoperative bleeding as a result of inhibited platelet aggregation, but should be continued if necessary to treat the patient's underlying chronic medical condition [32].…”

Section: Cardiovascular System: Physiologic Changes and Pharmacologic Omentioning

confidence: 99%

Pharmacologic Management of the Older Woman Undergoing Surgery

Chiang

Gerten

Granieri

et al. 2009

Womens Health (Lond Engl)

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Surgical intervention for both emergency and elective surgeries will increase as women live longer and maintain active lifestyles. Older women with operable conditions tolerate elective gynecologic and other nonvascular surgery with acceptable morbidity and mortality. However, increased medical comorbidities with associated increase in polypharmacy and perioperative risks as women age make it important to a priori optimize medical conditions and medication management perioperatively. Other considerations include assessing functional and cognitive status as these may be impaired acutely with increase prevalence of drug use during surgical hospitalization. With aging and postmenopausal status, changes associated with aging appear to play a greater role than gender in pharmacologic responses. Surgical outcomes should be optimize to maintain and even improve patients’ quality of life.

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Stopping and restarting medications in the perioperative period

Cited by 26 publications

References 71 publications

Thirty‐day mortality risk associated with the postoperative nonresumption of angiotensin‐converting enzyme inhibitors: A retrospective study of the veterans affairs healthcare system

Thirty‐day mortality risk associated with the postoperative nonresumption of angiotensin‐converting enzyme inhibitors: A retrospective study of the veterans affairs healthcare system

Sinus Bone Graft - Where and Where Not to be? - A Review

Pharmacologic Management of the Older Woman Undergoing Surgery

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