Article
Safety first? Drug-related problems at admission to surgery: A retrospective study
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Authors
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Stephanie Clemens
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
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Clara Simon
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
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Karin Kanduth
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
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Olaf Rose
- Institute of Pharmacy, Pharmaceutical Biology and Clinical Pharmacy, Paracelsus Medical University, Salzburg, Austria
| Published: | November 7, 2023 |
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Outline
Text
Background: Inappropriate preoperative management in medication may lead to unnecessary risks and complications. Research on medication management is scare for surgery. This study aimed to characterize emerging drug-related problems at admission in patients undergoing elective surgery.
Materials and methods: The study was designed as a retrospective, observational study at admission for nine different surgical sites at a university hospital. Included were all patients undergoing elective surgery in 2021 with ≥1 drug-related problems. The sample size was calculated considering 95% confidence interval and 5% precision. Prevalence and nature of drug-related problems during a medication review were classified according to the Pharmaceutical Network Europe classification of drug-related problems, V9.1 and the Hatoum scale of clinical significance. Drugs were grouped into the Anatomical-Therapeutic-Chemical classification system of the World Health Organization. The Charlson Comorbidity Index was applied to assess morbidity of participants. Analyses were conducted using descriptive statistics.
Results: The preliminary sample included >10,000 elective surgical patients. Participants’ most common morbidities were cancers (34%), diabetes mellitus with end organ damage (26%), and peripheral vascular diseases (19%). Around 2% of this sample showed drug-related problems. Major causes were drug-drug interactions and supra-therapeutic dosing. Most drug-related problems were rated as clinically significant. Cardiovascular drugs were the drug class of major concern. Half of the drug-related problems were caused by just a dozen of drugs. Simvastatin (interactions) and missing pantoprazole were typical examples.
Conclusion: The study showed that patients at surgery admissions totally differ from most medication review study cohorts. As drug-related problems are rare but meaningful, patient selection would contribute to an efficient process. At this stage of the hospital course, a medication review should mainly focus on medication safety aspects.
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