TY - JOUR
T1 - Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery
T2 - A Systematic Review
AU - Lee, Ji Won
AU - Li, Mengchi
AU - Boyd, Cynthia M.
AU - Green, Ariel R.
AU - Szanton, Sarah L.
N1 - Funding Information:
This work was supported in part by National Institutes of Health [grants R24AG064025 (S.L.S., A.R.G., and C.M.B.) and K24AG056578 (C.M.B.)].
Publisher Copyright:
© 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/4
Y1 - 2022/4
N2 - Objective: To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. Design: Systematic review. Setting and Participants: All available studies. Methods: We searched EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), and PubMed from inception to January 12, 2021. Settings included outpatient settings during the waiting period for surgery (ie, preoperative clinic) through to the preoperative period in the hospital. Participants who were older adults, aged ≥65 years, undergoing planned or emergency surgery with deprescribing or medication-related interventions were included for review. Results: We identified 3 different methods of deprescribing intervention delivery during the preoperative period: geriatrician-led (n = 2), interdisciplinary team-led (n = 8), and pharmacist-led (n = 6). Outcomes were related to health care utilization, patient outcomes, and medication changes; however, results were difficult to compare because of heterogeneous outcomes within the topics. Overall, results were either positive or neutral. Conclusions and Implications: The evidence for deprescribing during the preoperative period for older adults undergoing surgery is weak because of the heterogeneity of intervention delivery and outcomes, inclusion of nonoperative cases in some studies, and low power. This review highlights the need for future research, which may consider the following: (1) interdisciplinary approach, (2) coordination of deprescribing efforts with primary care provider from the waiting period for surgery up to after hospital discharge, and (3) validated deprescribing criteria such as STOPP/START that is easy to implement. It is important to note that results yielded positive and neutral results, not negative ones, which should reassure clinicians to implement deprescribing for older adults during the surgical period. Additionally, policy initiatives such as integrated electronic medical records or increased reimbursement of deprescribing efforts for primary care providers and/or hospitals should be pursued to prevent adverse postoperative events for this population.
AB - Objective: To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. Design: Systematic review. Setting and Participants: All available studies. Methods: We searched EMBASE, Cumulative Index of Nursing and Allied Health (CINAHL), and PubMed from inception to January 12, 2021. Settings included outpatient settings during the waiting period for surgery (ie, preoperative clinic) through to the preoperative period in the hospital. Participants who were older adults, aged ≥65 years, undergoing planned or emergency surgery with deprescribing or medication-related interventions were included for review. Results: We identified 3 different methods of deprescribing intervention delivery during the preoperative period: geriatrician-led (n = 2), interdisciplinary team-led (n = 8), and pharmacist-led (n = 6). Outcomes were related to health care utilization, patient outcomes, and medication changes; however, results were difficult to compare because of heterogeneous outcomes within the topics. Overall, results were either positive or neutral. Conclusions and Implications: The evidence for deprescribing during the preoperative period for older adults undergoing surgery is weak because of the heterogeneity of intervention delivery and outcomes, inclusion of nonoperative cases in some studies, and low power. This review highlights the need for future research, which may consider the following: (1) interdisciplinary approach, (2) coordination of deprescribing efforts with primary care provider from the waiting period for surgery up to after hospital discharge, and (3) validated deprescribing criteria such as STOPP/START that is easy to implement. It is important to note that results yielded positive and neutral results, not negative ones, which should reassure clinicians to implement deprescribing for older adults during the surgical period. Additionally, policy initiatives such as integrated electronic medical records or increased reimbursement of deprescribing efforts for primary care providers and/or hospitals should be pursued to prevent adverse postoperative events for this population.
KW - Preoperative
KW - deprescribing
KW - older adults
KW - polypharmacy
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85122914384&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122914384&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2021.11.005
DO - 10.1016/j.jamda.2021.11.005
M3 - Review article
C2 - 34861224
AN - SCOPUS:85122914384
SN - 1525-8610
VL - 23
SP - 528-536.e2
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 4
ER -