Barriers and facilitators to deprescribing before surgery: A qualitative study of providers and older adults.
Ji Won Lee, Suin Jeong, Hae-Ra Han and 7 others
PMID 37540907WHAT IT FOUND
Primary care providers and older adults awaiting hip or knee replacement were mostly open to reducing or stopping medicines before surgery, but trust, fear of symptoms returning, and lack of guidelines shaped whether they would do it.
Key findings
01Providers mostly saw reducing or stopping medicines before surgery as feasible and beneficial, especially for reducing drug interactions, medication costs, caregiver burden, and postoperative complications.
02Patients generally accepted the idea of stopping or withholding medicines before surgery, especially when they trusted their provider.
03Barriers included providers’ lack of deprescribing guidelines and resources, and patients’ fear that symptoms would return.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study interviewed only 8 providers and 8 patients from one health system, so themes may not apply elsewhere. Providers were mostly experienced physicians, which may not reflect junior providers or other staff. Patients were mostly White, had few social determinant challenges, and were excluded for screening-detected cognitive impairment, so it says little about more diverse or cognitively impaired older adults. Many eligible patients refused because of health reasons, and all were having elective hip or knee surgery, not emergency surgery. It is a qualitative interview study. It did not test a deprescribing intervention or measure medication changes, withdrawal events, or surgical outcomes.
Declared interests
One author reports being a co-author for UpToDate on multimorbidity and a reviewer for Dynamed for a chapter on falls. All other authors report no conflicts. The supplied text does not state who funded the study.
The easy way to misread this
Do not conclude that deprescribing before surgery improves surgical outcomes. This study only reports themes from 16 participants; it did not test a deprescribing intervention or measure postoperative complications.