Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery : retrospective, population-based cohort study

• Published in: BJS Open
• Main Authors: Jónsdóttir, Freyja, Blöndal, Anna Bryndís, Guðmundsson, Aðalsteinn, Bates, Ian, Stevenson, Jennifer M, Sigurðsson, Martin Ingi
• Other Authors: Other departments, Faculty of Pharmaceutical Sciences, Faculty of Medicine, Health Sciences
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2023
• Subjects: Lyfjafræðingar; Svæfinga- og gjörgæslulæknisfræði; Öldrunarlæknisfræði; Humans; Cohort Studies; Hospitalization; Polypharmacy; Retrospective Studies; Surgery; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/4211; https://doi.org/10.1093/bjsopen/zrad041

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Funding Information: This work was supported by the Foundation of St Josef’s Hospital in cooperation with the Icelandic Gerontological Research Centre, the National University Hospital of Iceland (to F.J.), the Landspitali University Hospital Science Fund (to M.I.S.), and the University of Iceland Research Fund (to F.J.). Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. Background: The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods: This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results: Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was ...