European Journal of Clinical Pharmacology

, Volume 67, Issue 5, pp 507–519 | Cite as

Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study

  • Alessandro NobiliEmail author
  • Giuseppe Licata
  • Francesco Salerno
  • Luca Pasina
  • Mauro Tettamanti
  • Carlotta Franchi
  • Luigi De Vittorio
  • Alessandra Marengoni
  • Salvatore Corrao
  • Alfonso Iorio
  • Maura Marcucci
  • Pier Mannuccio Mannucci
  • On behalf of SIMI Investigators
Pharmacoepidemiology and Prescription



We evaluated the prevalence and factors associated with polypharmacy and investigated the role of polypharmacy as a predictor of length of hospital stay and in-hospital mortality.


Thirty-eight internal medicine wards in Italy participated in the Registro Politerapie SIMI (REPOSI) study during 2008. One thousand three hundred and thirty-two in-patients aged ≥65 years were enrolled. Polypharmacy was defined as the concomitant use of five or more medications. Linear regression analyses were used to evaluate predictors of length of hospital stay and logistic regression models for predictors of in-hospital mortality. Age, sex, Charlson comorbidity index, polypharmacy, and number of in-hospital clinical adverse events (AEs) were used as possible confounders.


The prevalence of polypharmacy was 51.9% at hospital admission and 67.0% at discharge. Age, number of drugs at admission, hypertension, ischemic heart disease, heart failure, and chronic obstructive pulmonary disease were independently associated with polypharmacy at discharge. In multivariate analysis, the occurrence of at least one AE while in hospital was the only predictor of prolonged hospitalization (each new AE prolonged hospital stay by 3.57 days, p < 0.0001). Age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01–1.08; p = 0.02), comorbidities (OR 1.18; 95% CI 1.12–1.24; p < 0.0001), and AEs (OR 6.80; 95% CI 3.58–12.9; p < 0.0001) were significantly associated with in-hospital mortality.


Although most elderly in-patients receive polypharmacy, in this study, it was not associated with any hospital outcome. However, AEs were strongly correlated with a longer hospital stay and higher mortality risk.


Elderly Polypharmacy Hospital stay In-hospital mortality 



We thank Professor Farncesco Violi, President of the Italian Society of Internal Medicine, for his help and encouragement. We are grateful to Judith Baggott for editorial assistance.

Financial disclosure

Carlotta Franchi holds a fellowship granted by Rotary Clubs Milano Naviglio Grande San Carlo, Milano Scala and Inner Wheel Milano San Carlo.

Conflict of interest

All the authors declare that no conflict of interest exist. All the authors state that they have a full control of data and that they agree to allow the journal to review their data if requested.

Funding sources



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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Alessandro Nobili
    • 1
    Email author
  • Giuseppe Licata
    • 3
  • Francesco Salerno
    • 4
  • Luca Pasina
    • 1
  • Mauro Tettamanti
    • 2
  • Carlotta Franchi
    • 1
  • Luigi De Vittorio
    • 1
  • Alessandra Marengoni
    • 5
  • Salvatore Corrao
    • 3
  • Alfonso Iorio
    • 6
  • Maura Marcucci
    • 6
  • Pier Mannuccio Mannucci
    • 7
  • On behalf of SIMI Investigators
  1. 1.Laboratory for Quality Assessment of Geriatric Therapies and Services“Mario Negri” Institute for Pharmacological ResearchMilanItaly
  2. 2.Laboratory of Geriatric Neuropsychiatry“Mario Negri” Institute for Pharmacological ResearchMilanItaly
  3. 3.Dipartimento Biomedico di Medicina Interna e SpecialisticaUniversity of PalermoPalermoItaly
  4. 4.Medicina Interna, IRCCS Policlinico San DonatoUniversity of MilanoMilanItaly
  5. 5.Department of Medical and Surgery SciencesUniversity of Brescia Geriatric Ward, Spedali CiviliBresciaItaly
  6. 6.Department of Internal MedicineUniversity of PerugiaPerugiaItaly
  7. 7.Scientific Direction, IRCCS Cà Granda Foundation Maggiore Policlinico HospitalMilanItaly

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