Association of polypharmacy and perioperative outcomes: Systematic review and meta-analysis.
Yixuan Lee, Yixin Liew, Mui Hian Sim and 1 others
PMID 40012179WHAT IT FOUND
Surgical patients taking five or more medicines were more likely to have postoperative delirium, die within 30 days, or be discharged to another care facility.
They were not more likely to be admitted to ICU.
Key findings
01Across five studies, polypharmacy was significantly associated with postoperative delirium (OR 1.62, 95% CI 1.32-1.98).
02In three pooled studies, polypharmacy was significantly associated with 30-day mortality (OR 5.28, 95% CI 2.50-11.17).
03Polypharmacy was significantly associated with discharge to another care facility (OR 1.68, 95% CI 1.08-2.61), but was not significantly associated with ICU admission (OR 1.73, 95% CI 0.96-3.10).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The studies were observational, so they show association rather than proof that polypharmacy causes worse outcomes. The pooled odds ratios were unadjusted, so frailty, comorbidity and surgery type may explain the findings. Only three studies were pooled for 30-day mortality and two for discharge and ICU admission. The mortality estimate became more heterogeneous when one study was removed. No review protocol was registered before the work began. Definitions of polypharmacy and perioperative outcomes varied across studies.
Declared interests
The authors declared no conflicts of interest and received no funding.
The easy way to misread this
Do not conclude that stopping medicines before surgery will improve outcomes. The studies were observational and unadjusted. The mortality estimate came from three studies and became more heterogeneous when one study was removed. The authors also say deprescribing evidence is weak and can cause harms.