Abstract
Background
Potentially inappropriate medication (PIM) administration in geriatric surgical patients is increasingly prevalent in the perioperative period. The relation between the variation in PIM exposure and other key postoperative geriatric outcomes, such as postoperative hospital length of stay (POLOS), however, has seldom been reported, and current researches mentioning perioperative PIM concentrate on preoperative long-term home medications or postoperative prescriptions that may not be actually taken. We aimed to investigate whether the level and the change of short-term PIM exposure in the immediate perioperative period was associated with prolonged POLOS (pPOLOS).
Methods
We performed a retrospective cohort study of patients ≥ 65 years of age who underwent elective inpatient surgery at a tertiary academic hospital from July 2022 and March 2023. PIMs were defined using the Beers Criteria as suggested by the American Geriatrics Society. Stage-varying exposure variables were used to quantify cumulative PIM exposure levels during the preoperative (Pre-PIMs), intraoperative (Intra-PIMs), and even the entire perioperative stage period (Total-PIMs, represented by summing Pre-PIMs and Intra-PIMs) for each participant. A multivariable logistic model and restricted cubic spline model were applied to explore the association and dose-response relationship of PIM exposure with the risk of pPOLOS in the total population and subgroups.
Results
196 (44.6%) of 439 participants had a prolonged postoperative length of stay. There was PIM exposure in 378 (86.1%) of the current cohort, analgesics were administered most frequently both preoperatively and intraoperatively albeit via quite different mechanisms of action. Compared to participants without PIM exposure, only those with continuous exposure to Pre-PIM and Intra-PIM (high exposure group) significantly increased risk of pPOLOS with an adjusted OR of 3.13 (95% CI: 1.24-8.80, P = 0.021). The effect of Total-PIMs on pPOLOS risk (OR: 1.21, 95%CI: 1.06-1.40, P = 0.006) was more significant than that of Pre-PIMs or Intra-PIMs, and also showed a more obvious linear dose-response trend visually in the restricted cubic spline analysis. In subgroup analysis, significant modification effects of Charlson Comorbidity Index on the association of Total-PIMs with pPOLOS risk were observed.
Conclusion
Combined exposure to Pre-PIMs and Intra-PIMs more independently indicates the risk of pPOLOS in older patients than its individual exposure. These findings could help clinicians to be aware of the possible vulnerability of elderly patients under continued preoperative to intraoperative exposure to PIMs, and highlight the potential value of medication optimization and deprescribing PIMs in the immediate perioperative setting.