Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan.
BMC Geriatr. 2023 Mar 24;23(1):169. doi: 10.1186/s12877-023-03853-x.
Polypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain and have a high frequency of comorbidity are predicted to take many drugs. However, no studies have reported polypharmacy in elderly patients with LSS. Thus, we aimed to review the polypharmacy among elderly LSS patients with elective surgeries and examine how the surgical treatment reduces the polypharmacy.
We retrospectively enrolled all the patients aged ≥ 65 years who underwent spinal surgery for LSS between April 2020 and March 2021. The prescribed drugs of participants were directly checked by pharmacists in the outpatient department preoperatively and 6-month and 1-year postoperatively. The baseline characteristics were collected beside the patient-based outcomes including Roland-Morris Disability Questionnaire, Zurich Claudication Questionnaire, and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The cutoff number of drugs for polypharmacy was defined as 6. The prescription drugs were divided into 9 categories: drugs for neuropsychiatric, cardiovascular, respiratory, digestive, endocrine metabolic, and urinary renal diseases; blood products; pain relief medication; and others.
A total of 102 cases were finally analyzed, with a follow-up rate of 78.0%. Of the participants, the preoperative polypharmacy prevalence was 66.7%. The number of drugs 6-month and 1-year postoperatively was significantly less than the preoperative one. The proportions of polypharmacy at 6 months and 1 year after surgery significantly decreased to 57.8% and 55.9%, respectively. When the prescribed drugs were divided into 9 categories, the number of drugs for pain relief and digestive diseases was significantly reduced after surgery. The multi-variable analysis revealed that a higher score in the psychological disorder of JOABPEQ was associated with 3 or more drugs decreased 1-year postoperatively (OR, 2.5; 95% CI: 1.0-6.1).
Polypharmacy prevalence was high among elderly LSS patients indicated for lumbar spinal surgery. Additionally, our data showed that lumbar spinal surgery was effective in reducing polypharmacy among elderly LSS patients. Finally, the multi-variable analysis indicated that better psychological condition was associated with the reduction of prescribed drugs after lumbar spinal surgery.
在全球所有医疗保健环境中，多药治疗是一个日益严重的公共卫生问题。表现出腰痛和神经病理性疼痛且合并症高发的腰椎管狭窄症（LSS）老年患者预计会服用多种药物。然而，目前尚无研究报告 LSS 老年患者的多药治疗情况。因此，我们旨在回顾择期手术治疗的 LSS 老年患者的多药治疗情况，并探讨手术治疗如何减少多药治疗。
我们回顾性纳入了 2020 年 4 月至 2021 年 3 月期间因 LSS 接受脊柱手术的所有年龄≥65 岁的患者。术前由药剂师直接在门诊检查患者的处方药物，并在术后 6 个月和 1 年进行检查。收集患者的基线特征，包括 Roland-Morris 残疾问卷、苏黎世跛行问卷和日本矫形协会腰痛评估问卷（JOABPEQ）。多药治疗的药物数量定义为 6。将处方药物分为 9 类：神经精神疾病、心血管、呼吸、消化、内分泌代谢和泌尿肾病药物；血液制品；止痛药物；和其他药物。
共分析了 102 例患者，随访率为 78.0%。其中，术前多药治疗的患病率为 66.7%。术后 6 个月和 1 年的药物数量明显少于术前。术后 6 个月和 1 年的多药治疗比例分别显著下降至 57.8%和 55.9%。当将处方药物分为 9 类时，术后止痛和消化系统疾病的药物数量明显减少。多变量分析显示，JOABPEQ 心理障碍评分较高与术后 1 年减少 3 种或以上药物相关（OR，2.5；95%CI：1.0-6.1）。
拟行腰椎手术的 LSS 老年患者的多药治疗患病率较高。此外，我们的数据表明，腰椎手术可有效减少 LSS 老年患者的多药治疗。最后，多变量分析表明，更好的心理状况与腰椎手术后减少处方药物有关。
