Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
J Clin Pharm Ther. 2019 Aug;44(4):561-564. doi: 10.1111/jcpt.12816. Epub 2019 Feb 21.
Inadequate management of chronic medication puts patients at risk and causes unnecessary suspension of surgical procedures. The objective of the study was to calculate the rate of cancellation of elective surgical procedures due to inadequate management of chronic medications and to analyse the underlying causes of cancellation.
We designed an analytic, observational, retrospective study of all elective surgical procedures performed from July to October 2017 in a tertiary hospital. The main variable was the percentage of surgeries cancelled owing to inadequate management of chronic medications. Other variables recorded included demographic characteristics, time between the preanaesthesia evaluation and surgery, drug involved, and the reason for incorrect management of the medication.
During the study period, 5415 surgical procedures were programmed, and 793 (14.6%) were cancelled. Cancellations due to inadequate patient preparation accounted for 5.3% (42 cases), and 19 were related to incorrect medication management (2.4% of the total number of cancellations). The 19 patients, who were mostly men (73.7%), had a median age of 76 years (IQR 68-81). The drugs involved were acenocoumarol (6), enoxaparin (4), clopidogrel (4), direct-acting oral anticoagulants (2), acetylsalicylic acid (1), tocilizumab (1) and leflunomide (1). The reasons for drug mishandling were poor understanding of the anaesthesiology recommendations (15) and lack of a preanaesthesia evaluation (4).
Inadequate management of chronic medications (2.4%) is not the most frequent reason for cancellation, although it is one of the easiest to avoid. Based on our results, starting in October 2017, the Pharmacy Department began to offer a pharmaceutical service to patients with doubts about the preoperative management of chronic medications.
慢性药物管理不当会使患者面临风险，并导致不必要的手术程序暂停。本研究的目的是计算因慢性药物管理不当而取消的择期手术程序的比例，并分析取消的根本原因。
我们设计了一项分析性、观察性、回顾性研究，纳入了 2017 年 7 月至 10 月在一家三级医院进行的所有择期手术程序。主要变量是因慢性药物管理不当而取消手术的比例。其他记录的变量包括人口统计学特征、麻醉前评估和手术之间的时间、涉及的药物以及药物管理不当的原因。
在研究期间，计划了 5415 例手术，其中 793 例（14.6%）被取消。因患者准备不充分而取消的手术占 5.3%（42 例），19 例与药物管理不当有关（占总取消手术的 2.4%）。这 19 名患者主要为男性（73.7%），中位年龄为 76 岁（IQR 68-81）。涉及的药物有 acenocoumarol（6）、enoxaparin（4）、clopidogrel（4）、直接作用的口服抗凝剂（2）、乙酰水杨酸（1）、tocilizumab（1）和 leflunomide（1）。药物处理不当的原因是对麻醉科建议理解不佳（15 例）和缺乏麻醉前评估（4 例）。
慢性药物管理不当（2.4%）不是取消的最常见原因，但却是最容易避免的原因之一。根据我们的结果，自 2017 年 10 月起，药剂科开始为对慢性药物术前管理有疑问的患者提供药学服务。
