Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review.
Preoperative Deprescribing for Medical Optimization of Older Adults Undergoing Surgery: A Systematic Review.
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DOI：
10.1016/j.jamda.2021.11.005
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发表时间：
2022-04
影响因子：
7.6
通讯作者：
Szanton SL
中科院分区：
文献类型：
--
作者：
Lee JW;Li M;Boyd CM;Green AR;Szanton SL
To summarize the evidence for preoperative deprescribing and its effect on postoperative outcomes in older adults undergoing surgery. Systematic review All available studies. 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 (i.e., preoperative clinic) through to the preoperative period in the hospital. Participants who were older adults 65 and older undergoing planned or emergency surgery with deprescribing or medication-related interventions were included for review. 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 healthcare utilization, patient outcomes, and medication changes; however, results were difficult to compare due to heterogeneous outcomes within the topics. Overall, results were either positive or neutral. The evidence for deprescribing during the preoperative period for older adults undergoing surgery is weak due to heterogeneity of intervention delivery and outcomes, inclusion of non-operative 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 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 (EMR) or increased reimbursement of deprescribing efforts for primary care providers and/or hospitals should be pursued to prevent adverse postoperative events for this population. Older adults with multimorbidity undergoing surgery are at a higher risk for adverse drug events. Current limited evidence for deprescribing, medication optimization, during the surgical period warrants high-quality research.
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影响因子：
4.1
作者：
Ibrahim K;Cox NJ;Stevenson JM;Lim S;Fraser SDS;Roberts HC
通讯作者：
Roberts HC
影响因子：
4.2
作者：
Gleich, Johannes;Pfeufer, Daniel;Neuerburg, Carl
通讯作者：
Neuerburg, Carl
影响因子：
3.4
作者：
Boersma, Marijke Nynke;Huibers, Corlina Johanna Alida;Knol, Wilma
通讯作者：
Knol, Wilma
影响因子：
3.8
作者：
Carli, Francesco;Baldini, Gabriele
通讯作者：
Baldini, Gabriele
DOI：
10.1001/jama.2015.13766
发表时间：
2015-11-03
期刊：
JAMA
影响因子：
--
作者：
Kantor ED;Rehm CD;Haas JS;Chan AT;Giovannucci EL
通讯作者：
Giovannucci EL