Patterns, Predictors and Outcomes of Polypharmacy among Elderly Perioperative Patients in the General Surgical Department of a Tertiary Care Teaching Hospital
Department of Pharmacology, 1Department of General Surgery, St. John’s Medical College, Bengaluru-560 034, India
Department of Pharmacology, 1Department of General Surgery, St. John’s Medical College, Bengaluru-560 034, India, E-mail: [email protected]
Polypharmacy is the use of 5 or more medications per day and high level polypharmacy is the use of 10 medications or more per day by a patient. Perioperative patients form a significantly large population who are prescribed additional drugs for pain relief and infection prophylaxis. This study is aimed to estimate the prevalence of polypharmacy among perioperative elderly patients and to determine the predictors and outcomes of polypharmacy. This was a prospective observational study conducted among elderly patients aged 60 years or more who were admitted to the surgical wards for elective or emergency surgical procedures at a tertiary care teaching hospital from May 2014 to April 2015. Data were collected using a structured case report format. Descriptive statistics were used to summarise demographic characteristics, prescription patterns and outcomes. Predictors were evaluated using univariate analysis followed by regression analysis. About 135 patients were screened and 117 patients were included in the study. Prevalence of polypharmacy was 84.6% and prevalence of high level polypharmacy was 11.1%. The most common drugs related to surgery being used were pantoprazole (87.2%), pethidine (64.1%) and ondansetron (46.2%). Whereas, the most common surgery unrelated drugs prescribed were short acting human insulin (36.8%), amlodipine (29.1%) and metformin (22.2%). The number of adverse drug reactions encountered in our study was 7 and none was life threatening. The duration of hospital stay (adjusted odds ratio; 95% confidence intervals: 2.505; 1.239, 5.064) and number of co-morbidities (adjusted odds ratio; 95% confidence intervals: 1.927; 1.057, 3.514) were the significant predictors of polypharmacy. In conclusion, polypharmacy was high among elderly perioperative patients in our setting. Comorbidities and prolonged duration of hospital stay were important predictors of polypharmacy in elderly surgical patients.