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Association of preoperative medication with postoperative length of stay in elderly patients undergoing hip fracture surgery

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Abstract

Background

For elderly patients who are about to undergo surgery, research on the effects of preoperative medication on postoperative outcomes is rare, especially preoperative discontinuation-requiring medication (PDRM) which needed to be discontinued because of its increased risk of postoperative complications.

Aim

To investigate whether preoperative medication (PDRM and polypharmacy) is associated with postoperative length of hospital stay (LOS) in elderly patients undergoing hip fracture surgery.

Methods

Patients aged ≥ 65 who were scheduled for hip (limited to femoral tuberosity) fracture surgery were included. Baseline characteristics, preoperative medication and postoperative LOS were collected from the electronic medical record. The primary outcome was postoperative LOS.

Results

A total of 369 hip fracture patients were included. There were 188 and 122 patients exposed to PDRM and polypharmacy, respectively. Multivariate analysis models were constructed using significant factors for prolonged postoperative hospital stay from univariate analysis: Model I (body mass index (BMI), Charlson comorbidity index (CCI) ≥ 7, creatinine clearance rate (Ccr) < 60 and PDRM) and Model II (BMI, Ccr ≥ 7, Ccr < 60 and polypharmacy). CCI was the most significant factor. Its adjusted odds ratio was as large as 2.7 and attributable risk was 63%. In preoperative medication use, both polypharmacy and PDRM showed significant association with postoperative LOS.

Conclusion

The present study supported the impact of PDRM on postoperative LOS in geriatric hip fracture patients. The results added a further aspect to preoperative medication optimization in elderly patients undergoing hip fracture surgery.

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References

  1. The Anaesthesia and Perioperative Care Priority Setting Partnership (2015). https://niaa.org.uk/Results#pt. Accessed 8 June 2017

  2. Lakomkin N, Zuckerman SL, Stannard B et al (2019) Preoperative risk stratification in spine tumor surgery a comparison of the modified Charlson Index, Frailty Index, and ASA Score. Spine 44:E782–E787. https://doi.org/10.1097/Brs.0000000000002970

    Article  PubMed  Google Scholar 

  3. Yu CS, Jung SW, Lee JL et al (2019) The influence of preoperative medications on postoperative complications in patients after intestinal surgery for Crohn's disease. Inflamm Bowel Dis 25:1559–1568. https://doi.org/10.1093/ibd/izz010

    Article  PubMed  Google Scholar 

  4. Vashishta R, Kendale SM (2019) Relationship between preoperative antidepressant and antianxiety medications and postoperative hospital length of stay. Anesth Analg 128:248–255. https://doi.org/10.1213/Ane.0000000000003910

    Article  PubMed  Google Scholar 

  5. Diep DB, Wong C, van Walraven C et al (2018) Association of preoperative anticholinergic medication exposure with postoperative healthcare resource use and outcomes: a population-based cohort study. Anesth Analg 126:595–596

    Google Scholar 

  6. McIsaac DI, Wong CA, Bryson GL et al (2018) Association of polypharmacy with survival, complications, and healthcare resource use after elective noncardiac surgery. Anesthesiology 128:1140–1150. https://doi.org/10.1097/Aln.0000000000002124

    Article  PubMed  Google Scholar 

  7. Jeong YM, Lee KE, Lee ES et al (2018) Preoperative medication use and its association with postoperative length of hospital stay in surgical oncology patients receiving comprehensive geriatric assessment. Geriatr Gerontol Int 18:12–19. https://doi.org/10.1111/ggi.13127

    Article  PubMed  Google Scholar 

  8. Choi KS, Jeong YM, Lee E et al (2018) Association of pre-operative medication use with post-surgery mortality and morbidity in oncology patients receiving comprehensive geriatric assessment. Aging Clin Exp Res 30:1177–1185. https://doi.org/10.1007/s40520-018-0904-2

    Article  PubMed  Google Scholar 

  9. Samuelsson KS, Egenvall M, Klarin I et al (2016) Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis 18(2):155–162. https://doi.org/10.1111/codi.13077

    Article  CAS  PubMed  Google Scholar 

  10. Duceppe E, Lussier AR, Beaulieu-Dore R et al (2018) Preoperative antihypertensive medication intake and acute kidney injury after major vascular surgery. J Vasc Surg 67:1872. https://doi.org/10.1016/j.jvs.2017.10.065

    Article  PubMed  Google Scholar 

  11. McChesney SL, Canter DJ, Monlezun DJ et al (2020) Modified Frailty Index predicts postoperative outcomes in patients undergoing radical pelvic surgery. Am Surg 86:95–103

    Article  Google Scholar 

  12. Jeon MS, Jeong YM, Yee J et al (2019) Association of pre-operative medication use with unplanned 30-day hospital readmission after surgery in oncology patients receiving comprehensive geriatric assessment. Am J Surg. https://doi.org/10.1016/j.amjsurg.2019.06.020

    Article  PubMed  Google Scholar 

  13. Castanheira L, Fresco P, Macedo AF (2011) Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther 36:446–467. https://doi.org/10.1111/j.1365-2710.2010.01202.x

    Article  CAS  PubMed  Google Scholar 

  14. Wang K, Shen J, Jiang D et al (2019) Development of a list of high-risk perioperative medications for the elderly: a Delphi method. Expert Opin Drug Saf 18:853–859. https://doi.org/10.1080/14740338.2019.1629416

    Article  PubMed  Google Scholar 

  15. Jeong YM, Lee E, Kim KI et al (2016) Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment. BMC Geriatr. https://doi.org/10.1186/s12877-016-0311-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chopra I, Wilkins TL, Sambamoorthi U (2016) Hospital length of stay and all-cause 30-day readmissions among high-risk medicaid beneficiaries. J Hosp Med 11:283–288. https://doi.org/10.1002/jhm.2526

    Article  PubMed  Google Scholar 

  17. Reynolds K, Butler MG, Kimes TM et al (2015) Relation of acute heart failure hospital length of stay to subsequent readmission and all-cause mortality. Am J Cardiol 116:400–405. https://doi.org/10.1016/j.amjcard.2015.04.052

    Article  PubMed  Google Scholar 

  18. Nikkel LE, Kates SL, Schreck M et al (2015) Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study. BMJ Brit Med J. https://doi.org/10.1136/bmj.h6246

    Article  PubMed  Google Scholar 

  19. Heyes GJ, Tucker A, Marley D et al (2015) Predictors for readmission up to 1 year following hip fracture. Arch Trauma Res 4:e27123. https://doi.org/10.5812/atr.4(2)2015.27123

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kaboli PJ, Go JT, Hockenberry J et al (2012) Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 veterans affairs hospitals. Ann Intern Med 157:837–U161. https://doi.org/10.7326/0003-4819-157-12-201212180-00003

    Article  PubMed  Google Scholar 

  21. Abdel MP, Ast MP, Lee YY et al (2014) All-cause in-hospital complications and urinary tract infections increased in obese patients undergoing total knee arthroplasty. J Arthroplasty 29:1430–1434. https://doi.org/10.1016/j.arth.2014.02.013

    Article  PubMed  Google Scholar 

  22. Springer BD, Parvizi J, Austin M et al (2013) Obesity and total joint arthroplasty a literature based review. J Arthroplasty 28:714–721. https://doi.org/10.1016/j.arth.2013.02.011

    Article  Google Scholar 

  23. Johnson D, Greenberg S, Sathiyakumar V et al (2015) Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled payment. J Orthop Traumatol 16:209–213. https://doi.org/10.1007/s10195-015-0337-z

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lakomkin N, Goz V, Lajam CM et al (2017) Higher modified Charlson Index Scores are associated with increased incidence of complications, transfusion events, and length of stay following revision hip arthroplasty. J Arthroplasty 32:1121–1124. https://doi.org/10.1016/j.arth.2016.11.014

    Article  PubMed  Google Scholar 

  25. Ondeck NT, Bohl DD, Bovonratwet P et al (2018) Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index. Spine J 18:44–52. https://doi.org/10.1016/j.spinee.2017.05.028

    Article  PubMed  Google Scholar 

  26. Ondeck NT, Bohl DD, Bovonratwet P et al (2018) Predicting adverse outcomes after total hip arthroplasty: a comparison of demographics, the American Society of Anesthesiologists class, the modified Charlson Comorbidity Index, and the Modified Frailty Index. J Am Acad Orthop Sur 26:735–743. https://doi.org/10.5435/Jaaos-D-17-00009

    Article  Google Scholar 

  27. Mooney JF, Ranasinghe I, Chow CK et al (2013) Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery a systematic review and meta-analysis. Anesthesiology 118:809–824. https://doi.org/10.1097/ALN.0b013e318287b72c

    Article  PubMed  Google Scholar 

  28. McClung CD, Zahiri CA, Higa JK et al (2000) Relationship between body mass index and activity in hip or knee arthroplasty patients. J Orthop Res 18:35–39. https://doi.org/10.1002/jor.1100180106

    Article  CAS  PubMed  Google Scholar 

  29. Blitz JD, Shoham MH, Fang YX et al (2016) Preoperative renal insufficiency: underreporting and association with readmission and major postoperative morbidity in an Academic Medical Center. Anesth Analg 123:1500–1515. https://doi.org/10.1213/Ane.0000000000001573

    Article  PubMed  Google Scholar 

  30. Squires MH, Mehta VV, Fisher SB et al (2014) Effect of preoperative renal insufficiency on postoperative outcomes after pancreatic resection: a single institution experience of 1061 consecutive patients. J Am Coll Surg 218:92–101. https://doi.org/10.1016/j.jamcollsurg.2013.09.012

    Article  PubMed  Google Scholar 

  31. Ackland GL, Moran N, Cone S et al (2011) Chronic kidney disease and postoperative morbidity after elective orthopedic surgery. Anesth Analg 112:1375–1381. https://doi.org/10.1213/ANE.0b013e3181ee8456

    Article  PubMed  Google Scholar 

  32. Dunne TJ, Gaboury I, Ashe MC (2014) Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract 20:396–400. https://doi.org/10.1111/jep.12144

    Article  PubMed  Google Scholar 

  33. Kerper LF, Spies CD, Buspavanich P et al (2014) Preoperative depression and hospital length of stay in surgical patients. Minerva Anestesiol 80:984–991

    CAS  PubMed  Google Scholar 

  34. Krampe H, Barth-Zoubairi A, Schnell T et al (2018) Social relationship factors, preoperative depression, and hospital length of stay in surgical patients. Int J Behav Med 25:658–668. https://doi.org/10.1007/s12529-018-9738-8

    Article  PubMed  Google Scholar 

  35. Potretzke AM, Kim EH, Knight BA et al (2016) Patient comorbidity predicts hospital length of stay after robot-assisted prostatectomy. J Robot Surg 10:151–156. https://doi.org/10.1007/s11701-016-0588-6

    Article  PubMed  Google Scholar 

  36. Soong C, Cram P, Chezar K et al (2016) Impact of an integrated hip fracture inpatient program on length of stay and costs. J Orthop Trauma 30:647–652. https://doi.org/10.1097/Bot.0000000000000691

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Tianlong Wang (M.D., Ph.D., Department of Anesthesia, Xuanwu Hospital, Capital Medical University) for his contributions to the study design. We would also like to thank Dr. Kun Yang (Evidence-based medicine center, Xuanwu Hospital, Capital Medical University) for his contributions to statistical analysis. Finally, we would like to thank Dr. Chao Kong (M.D., Department of Orthopedic, Xuanwu Hospital, Capital Medical University) for his assistance with the data collection process.

Funding

This research was supported by Beijing Municipal commission of Health and Family Planning (No. PXM2017_026283_000002). The content is solely the responsibility of the authors and does not necessarily represent the official views of Beijing Municipal commission of Health and Family Planning. It had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, 45 Changchun Street, Xicheng District, Beijing, 100053, China

    Jianghua Shen, Yanqi Chu & Suying Yan

  2. School of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, China

    Yahui Yu

  3. National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China

    Chaodong Wang

Authors
  1. Jianghua Shen
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  2. Yahui Yu
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  4. Yanqi Chu
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  5. Suying Yan
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Contributions

JS: study design, data collection, statistical analysis and manuscript writing. YY: data collection and statistical analysis. CW: study design and statistical analysis. YC: study design. SY: study design.

Corresponding author

Correspondence to Suying Yan.

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Conflict of interest

All authors declare that they have no competing interests. This study was approved by the Ethical review committee of Beijing Xuanwu Hospital, Capital Medical University. This work was performed at Beijing Xuanwu Hospital of Capital Medical University and National Clinical Research Center for Geriatric Diseases.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (the ethics committee of Xuanwu Hospital of Capital Medical University Approval 临研审 No. 086 (2018)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of human and animal rights.

This study was approved by the ethics committee of Xuanwu Hospital of Capital Medical University Approval (临研审No. 086【2018】). IRB waived the requirement for informed consent from the patients.

Informed consent

This study is a retrospective observational study using existing data from medical records. IRB waived the requirement for informed consent from the patients according to the ethical guidelines for medical and health research involving human subjects in China.

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All data come from the electronic medical record system of Xuanwu Hospital.

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Shen, J., Yu, Y., Wang, C. et al. Association of preoperative medication with postoperative length of stay in elderly patients undergoing hip fracture surgery. Aging Clin Exp Res 33, 641–649 (2021). https://doi.org/10.1007/s40520-020-01567-3

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