POLYPHARMACY CHALLENGES IN GERIATRIC SURGICAL PATIENTS WITH MEDICAL AND PSYCHIATRIC COMORBIDITIES: A HOSPITAL-BASED OBSERVATIONAL STUDY
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Keywords
Polypharmacy, Geriatric surgery, Psychiatric comorbidity, Drug–drug interactions, Potentially inappropriate medications
Abstract
Polypharmacy is a major clinical issue in geriatric surgery, especially where the patient has both medical and psychiatric comorbidities. This has a high possibility of negative medication responses and drug-drug interactions (DDIs), postoperative complications, and lengthy hospital stays since there is concurrent use of multiple drugs among this population group. This research work also differed in that it was intended to evaluate the prevalence, prescription practice, and clinical consequences of polypharmacy among elderly surgical patients with multimorbidity. Over a year, a prospective observational study was conducted at a teaching hospital in India that provides tertiary care. The research involved 170 subjects with 65 years of age or older and had undergone elective or emergency surgery, where each of them had at least one chronic medical condition and one diagnosed psychiatric disorder. Data were collected on demographics, clinical history, medication profiles, potentially inappropriate medications (PIMs), DDIs, and postoperative outcomes, and analyzed using descriptive and inferential statistical methods. The prevalence of polypharmacy (five or more medicines) was noted in 66.5% of patients, whereas excessive polypharmacy (ten or more medicines) was reported in 19.4% of the patients. PIMs were identified in 41.8% of patients, and 15.2% experienced severe DDIs. Postoperative delirium was observed in 12.4% of the cohort and was significantly associated with polypharmacy and psychotropic drug combinations. Patients exposed to polypharmacy had longer hospital stays and a higher incidence of 30-day readmissions. Emergency surgical status and psychiatric comorbidity independently predicted adverse outcomes. These findings emphasize the urgent need to integrate multidisciplinary medication reviews and geriatric-psychiatric assessments into perioperative care pathways to minimize medication-related harm and improve patient outcomes in elderly surgical populations.
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Dr. Manjula Shetty
Assistant Professor, KVG Medical College and Hospital, Sullia
Dr. Caroline Peter D'Souza
Assistant Professor, Kasturba Medical College, Mangalore
Dr. Sandesh K.S.
Assistant Professor, Department of Postgraduate Studies, Nehru Memorial College, Sullia
Dr. Leeladhar D.V.
Associate Professor of Ayurveda, KVG Medical College, Sullia
Dr. Shyam Krishna Ashok
Assistant Professor, KVG Medical College and Hospital, Sullia