• World Neurosurg · Aug 2022

    Preoperative Polypharmacy in Geriatric Patients is Associated with Increased 90-Day All-Cause Hospital Readmission After Surgery for Adult Spinal Deformity Patients.

    • Sai Chilakapati, Michael D Burton, and Owoicho Adogwa.
    • Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA.
    • World Neurosurg. 2022 Aug 1; 164: e404-e410.

    ObjectiveWe sought to investigate the effect of preoperative polypharmacy (PP) on the 90-day all-cause readmission rate in older adults undergoing corrective surgery for adult spinal deformity.MethodsOlder adults with a diagnosis of adult spinal deformity undergoing spinal surgery at a quaternary medical center from January 2016 to March 2019 were enrolled in this study. Patients were dichotomized into 2 groups stratified by the number of preoperative prescription medications, with PP defined as 5 or more prescription medications. The primary outcome measure was 90-day all-cause readmission rate. Secondary outcomes included postoperative changes in health-related quality of life measures.ResultsAmong 161 patients (mean [standard deviation], 69.59 [8.79] years), 97 patients were included in the PP cohort and 64 in the nonpolypharmacy (non-PP) cohort. Both groups were balanced at baseline. Duration of hospital stay (5.82 [1.93] vs. 6.50 [4.00] days), mean number of fusion levels, and duration of surgery were statistically similar between both groups (P > 0.05). There was no difference in the proportion of patients discharged directly home (31.25% vs. 40.42%, P = 0.36). The 90-day all-cause readmission rate was 3-fold higher in the PP cohort compared with the non-PP cohort. After adjusting for preoperative patient optimization, American Society of Anesthesiologists grade, surgical invasiveness, smoking, depression, and baseline functional disability, older adults with PP had a 9.79 increased odds of 90-day all-cause hospital readmission (P = 0.04). Changes in health-related quality of life measures were similar between both groups.ConclusionThis study's findings indicate that despite preoperative optimization, older adults exposed to polypharmacy are at a significantly increased risk of hospital readmission within 90 days of surgery.Copyright © 2022 Elsevier Inc. All rights reserved.

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