Freyja Jónsdóttir, Anna Bryndís Blöndal, Aðalsteinn Guðmundsson, Ian Bates, Jennifer Stevenson, Martin Ingi Sigurðsson
Introduction: Polypharmacy has been identified as the leading risk factor for potentially inappropriate prescribing. Beers criteria identify inappropriate prescribing. Older Individuals are increasingly being offered surgical care and are likely to be prescribed potentially inappropriate medications.
Objectives: The study aimed to determine the prevalence of preoperative prescribing of potentially inappropriate medications according to Beers criteria in a cohort of older surgical population.
Methods: Retrospective, population-based cohort study included all patients ≥65 years undergoing first surgery at The National University Hospital of Iceland between 2006-2018. Potentially inappropriate prescribing in the year prior to surgery was assessed using 2019 Beers criteria. Participants were categorized pre-and postoperatively based on the number of medications filled in the year, both pre-and post-surgery; categories were non-polypharmacy (<5), polypharmacy (5-10) and hyper-polypharmacy (>10).
Results: Among 17198 patients (54% female; mean age 75±7.5 years), the prevalence of inappropriate prescribing according to Beers criteria preoperatively was 38.2%, 81.0,% and 96.2% for non-polypharmacy, polypharmacy, and hyper-polypharmacy. The most prescribed medications that are potentially inappropriate according to Beers criteria were medications acting on the central nervous system and gastrointestinal medications. Among medication acting on the central nervous system, patients were most prescribed non-benzodiazepine hypnotic drugs known as „Z-drugs“ and benzodiazepines and within gastrointestinal medication, mostly proton-pump inhibitors.
Conclusions: According to Beer’s criteria, preoperative potentially inappropriate prescribing is common among older surgical patients and associated with polypharmacy and hyper-polypharmacy. An increased focus on optimizing medication usage in older surgical patients throughout the perioperative period could reduce the risk of potentially harmful outcomes.