Polypharmacy is predictive of postoperative complications in older adults undergoing ventral hernia repair

• Published in: Surgical endoscopy Vol. 36; no. 11; pp. 8387 - 8396
• Main Authors: Holden, Timothy R., Kushner, Bradley S., Hamilton, Julia L., Han, Britta, Holden, Sara E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2022; Springer Nature B.V
• Subjects: 2021 SAGES Oral; Abdominal Surgery; Aged; Delirium; Delirium - epidemiology; Gastroenterology; Gynecology; Hepatology; Hernia, Ventral - etiology; Hernia, Ventral - surgery; Herniorrhaphy - adverse effects; Humans; Medicine; Medicine & Public Health; Older people; Polypharmacy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Postoperative period; Proctology; Surgery; Delirium; Polypharmacy; TAR; Ventral hernia; Geriatrics
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-022-09099-9

Background
Ventral hernias are common in older adults, and may be repaired via a transversus abdominus release (TAR). Older adults undergoing surgery have unique age-related risk factors, including polypharmacy. Polypharmacy is highly prevalent in older adults and is associated with adverse postoperative outcomes. Our aim was to examine the prevalence and association of polypharmacy with clinical outcomes in older adults undergoing a TAR.
Methods
Patients 60 years and older who underwent elective open or robotic bilateral TAR were included in the study. Average daily medications taken preoperatively was collected and stratified by tertiles. Baseline demographic data, peri- and postoperative outcomes, and 30-day outcomes were collected.
Results
There were 132 total patients with an average age of 67.8 years. The number of daily medications ranged from 0 to 28, with an overall mean of 11.2 medications. Patients in tertile 1 took an average of 5.3 medications, tertile 2 10.5 medications, and tertile 3 17.9 medications. Patients in tertile 3 had more than double the rate of in-hospital complications (0.7) compared to tertiles 1 and 2 (0.3 and 0.3, respectively;
p
 = 0.03). A greater number of daily medications was independently associated with postoperative delirium [odds ratio (OR) 1.2, 95% confidence interval (CI) 1.0–1.3], cardiac events (OR 1.2, 95% CI 1.0–1.3), ICU stay (OR 1.2, 95% CI 1.0–1.3), and discharge to a skilled nursing facility (SNF) (OR 1.2, 95% CI 1.0–1.5).
Conclusions
Polypharmacy was very common in older adults undergoing a TAR, and was associated with in-hospital complications, postoperative delirium, cardiac events, ICU stay, length of stay, and discharge to a SNF. Additional study is needed to assess if preoperative interventions to limit polypharmacy will improve outcomes for older adults undergoing a TAR.