Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review.
Ji Won Lee, Mengchi Li, Cynthia M Boyd and 2 others
PMID 34861224WHAT IT FOUND
Preoperative deprescribing for older adults undergoing surgery showed mixed results.
Some high-risk elective surgery studies had shorter stays, fewer readmissions, or medication changes; others did not. Evidence quality was low, and results varied.
Key findings
01Hospital stay and readmission results were inconsistent: five studies reported shorter stays, but only two found a statistically significant reduction; two readmission studies found no significant difference, and one found lower 7-day and 30-day readmissions.
02Medication changes were reported in twelve studies, but only three found a statistically significant difference between groups.
03One study reported fewer all-type complications (44.8% versus 58.7% of patients) but higher delirium (28.4% versus 5.6% of patients).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review found no single clear answer because the 16 studies measured different outcomes, used different surgery types, and included some non-surgical patients. Study quality was low or uncertain: both randomized trials were at high risk of bias, and many other studies had moderate to serious risk. Only English-language, published studies were included, so unpublished or non-English work may change the picture. Follow-up was usually only during hospitalization, with some studies following patients for 30 days to 4 months, so long-term effects were not measured. Deprescribing after surgery or during transitions of care was not reviewed, so this does not address the whole perioperative period. No subgroup analyses were possible because designs and outcomes varied.
Declared interests
No funder is named in the supplied article text; the supplied publication types list NIH extramural research support. Dr. Cynthia M. Boyd is a co-author for UpToDate on multimorbidity and a reviewer for Dynamed for a chapter on falls; all other authors declared no conflicts.
The easy way to misread this
Do not conclude that preoperative deprescribing reliably improves surgery outcomes or is proven safe. The review was inconclusive, most studies were low quality, and one study showed fewer overall complications but more delirium.