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Preoperative Medication Management: Filling in the Gaps

Satish N. Nadig MD, PhD, Julie Anne Wright Nunes MD, MPH
Volume: 106 Issue: 8 August, 2013

Abstract:

Preoperative medication management is central to the delivery of high-quality surgical care. The successful management of patients through an operation must address medication concerns related to anesthesia, individual patient care needs, and the surgical procedure itself. The number of patients who require preoperative medication management is formidable, with half of all patients undergoing surgery on some type of medication.1 Moreover, the number of medications and complexity of management increase with patients who often require surgery, namely older patients and those with multiple comorbidities. Largely because of adverse events in medication management, patients taking medications before surgery have a three times higher risk of postoperative complications than those who are not taking medications.2 Effective preoperative management of medications is a critical part of optimizing a patient’s clinical status for best possible outcomes before, during, and after surgical procedures. Despite the abundance of literature available on preoperative and perioperative management, significant gaps remain for providers caring for surgical patient populations at high risk for poor outcomes.3

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References:

1. Kennedy JM, van Rij AM, Spears GF, et al. Polypharmacy in a general surgical unit and consequences of drug withdrawal. Br J Clin Pharmacol. 2000; 49: 353–362.
 
2. Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009; 76(Suppl 4):S126–S132.
 
3. Saber W . Perioperative medication management: a case-based review of general principles. Cleve Clin J Med. 2006;. 73(Suppl 1): S82–S87.
 
4. Castanheira L, Fresco P, Macedo AF. Guidelines for the management of chronic medication in the perioperative period: systematic review and formal consensus. J Clin Pharm Ther. 2011; 36: 446–467.
 
5. Mercado DL, Petty BG. Perioperative medication management. Med Clin North Am. 2003; 87: 41–57.
 
6. Mitruka SN, Griffith BP, Kormos RL, et al. Cardiac operations in solid-organ transplant recipients. Ann Thorac Surg. 1997; 64:1270–1278.
 
7. Lahey SJ, Dow RW, Maloney C, et al. Surgery risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass. Circulation. 2000; 102::2973–2977.
 
8. Palevsky PM. Perioperative management of patients with chronic kidney disease or ESRD. Best Pract Res Clin Anaesthesiol. 2004; 18: 129–144.
 
9. Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;; 236: 576–582.
 
10. Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203: 865–877.
 
11. Blazer DG, Wu LT. Nonprescription use of pain relievers by middle-aged and elderly community-living adults: National Survey on Drug Use and Health. J Am Geriatr Soc. 2009; 57: 1252–1257.
 
12. Wu LT, Pilowsky DJ, Patkar AA. Non-prescribed use of pain relievers among adolescents in the United States. Drug Alcohol Depend. 2008; 94: 1–11.

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