Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.
Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.
复制标题
潜在不适当的药物管理与老年手术患者的不良术后结果相关：一项回顾性队列研究。
DOI：
10.1213/ane.0000000000006185
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发表时间：
2022-11-01
影响因子：
5.7
通讯作者：
Schenning KJ
中科院分区：
文献类型：
--
作者：
Burfeind KG;Zarnegarnia Y;Tekkali P;O'Glasser AY;Quinn JF;Schenning KJ
美国老年医学会（AGS）Beers Criteria©是一份明确的列表，列出了65岁以上成人最好避免的潜在不适当药物（PIM）。认知功能受损和虚弱的手术患者通常在手术后结局不佳，但PIM对这些患者的影响尚不清楚。我们的目的是评估围手术期PIM管理是否与老年手术患者的不良结局相关。然后，我们在虚弱或认知功能受损的患者亚组中评估PIM给药与术后结局之间的相关性。我们对2018年2月至2020年1月在一家大型学术医疗中心接受择期住院手术的≥65岁患者进行了一项回顾性队列研究。在术前门诊访视时，对所有患者进行埃德蒙顿虚弱量表和Mini-Cog筛查工具。Mini-Cog评分为0-2被视为认知损害，虚弱定义为埃德蒙顿虚弱量表评分≥ 8。根据患者是否在围手术期接受至少一次PIM（PIM+）（基于2019年AGS Beers标准©）或无PIM（PIM−），将患者分为两组。我们采用多元回归分析评估了术前虚弱、认知功能障碍和围手术期PIM给药与住院时间和出院处置的相关性，调整了年龄、性别、阿萨身体状况和ICU入院情况。在纳入的1，627例患者（平均年龄73.7岁）中，69.3%（n= 1，128）接受了至少一次PIM。12.7%的患者身体虚弱，11.1%的患者存在认知功能障碍。64%的虚弱患者和58%的认知障碍患者接受了至少一次PIM。围手术期PIM给药与术后住院时间延长相关（PIM− 3.56±5.2 vs PIM+ 4.93±5.66天，P<0.001，95% CI 0.360，0.546）。接受PIM的虚弱患者的平均LOS比未接受PIM的虚弱患者长近2天（PIM− 4.48±5.04 vs PIM+ 6.33±5.89天，p=0.02）。多元回归分析显示，PIM管理与出院到护理机构的患者比例之间没有显著相关性（PIM+ 26.3% vs PIM− 28.7%，p=0.87，95%CI −0.046，0.054）。围手术期PIM给药在老年手术患者中很常见，包括认知受损和虚弱的患者。PIM管理与住院时间增加有关，特别是在虚弱的患者中。PIM管理和出院处置之间没有关联。
The American Geriatrics Society (AGS) Beers Criteria© is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients that were frail or cognitively impaired. We performed a retrospective cohort study of patients aged ≥65 years that underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0–2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score ≥ 8. Patients were divided into two groups depending on whether they received at least one PIM (PIM+), based on the 2019 AGS Beers Criteria©, in the perioperative period or none (PIM−). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA Physical status, and ICU admission. Of the 1,627 included patients (mean age 73.7 years), 69.3% (n=1,128) received at least one PIM. 12.7% of patients were frail and 11.1% of patients were cognitively impaired. 64% of the frail patients and 58% of the cognitively impaired patients received at least one PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM− 3.56±5.2 versus PIM+ 4.93±5.66 days, P<0.001, 95% CI 0.360, 0.546). Frail patients that received PIMs had an average LOS that was nearly 2 days longer than frail patients that did not receive PIMs (PIM− 4.48±5.04 versus PIM+ 6.33±5.89 days, p=0.02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+ 26.3% versus PIM− 28.7%, p=0.87, 95% CI −0.046, 0.054). Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital length of stay, particularly in frail patients. There was no association found between PIM administration and discharge disposition.