Retrospective multi-centre cohort study of polypharmacy, the Drug Burden Index and associations with outcomes in older surgical inpatients.

IF 7.1 2区医学 Q1 GERIATRICS & GERONTOLOGY

Age and ageing Pub Date : 2025-08-29 DOI:10.1093/ageing/afaf270

Bonnie Mengyuan Liu, Kenji Fujita, Janani Thillainadesan, Danijela Gnjidic, Sarah N Hilmer

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引用次数: 0

Abstract

Background: Comprehensive medication utilisation and its association with outcomes are not well described in older surgical inpatients.

Objectives: Investigate medication utilisation and the associations of the number of medications and exposure to anticholinergic and sedative medications measured using the Drug Burden Index (DBI exposure) with outcomes in older surgical inpatients.

Methods: A multi-centre retrospective cohort study of surgical patients ≥65 years at five Australian hospitals admitted for ≥48 hours, from 4 January 2022 to 3 January 2023. The number of regular medications was counted on admission and discharge. DBI exposure throughout admission was calculated using the area under the curve for DBI/days of admission (AUC DBI/days). Multilevel regression was conducted for outcomes on/during admission [falls, adverse drug events (ADEs), delirium, pressure ulcers, Hospital Frailty Risk Score (HFRS), length of stay (LOS)].

Results: The 13 815 participants (51.1% male) had a median (IQR) age of 77 (71-84) years. The median number of medications was 5 (2-9) on admission and 9 (6-13) on discharge. The median AUC DBI/days was 0.13 (0-0.5). The number of admission medications was associated with delirium [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04], ADEs (aOR 1.03, 95% CI: 1.01-1.04), pressure ulcers (aOR 1.04, 95% CI:1.02-1.06), HFRS [adjusted rate ratio (aRR) 1.01, 95% CI:1.001-1.02] and increased LOS (aRR 1.011, 95% CI: 1.008-1.014). The AUC DBI/days was associated with falls (aOR 1.29, 95% CI: 1.18-1.41), delirium (aOR 1.63, 95% CI:1.46-1.82), ADEs (aOR 1.26, 95% CI: 1.11-1.43), pressure ulcers (OR 1.60, 95% CI: 1.38-1.86), HFRS (aRR 1.27, 95% CI:1.17-1.37) and increased LOS (aRR 1.36, 95% CI:1.32-1.40).

Conclusion: Polypharmacy is common amongst older surgical inpatients, and the number of medications increased from admission to discharge. Increased DBI exposure was associated with adverse outcomes.

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老年外科住院患者多药、药物负担指数及其与预后的关联的回顾性多中心队列研究。

背景：在老年外科住院患者中，综合用药及其与预后的关系尚未得到很好的描述。目的：调查老年外科住院患者的药物使用情况，以及使用药物负担指数（DBI暴露）测量的抗胆碱能药物和镇静药物的数量和暴露与预后的关系。方法：对2022年1月4日至2023年1月3日在澳大利亚5家医院住院≥48小时的≥65岁外科患者进行多中心回顾性队列研究。在入院和出院时统计常规药物的使用次数。入院期间DBI暴露使用入院DBI/days （AUC DBI/days）曲线下面积计算。对入院时/入院期间的结局[跌倒、药物不良事件（ADEs）、谵妄、压疮、医院虚弱风险评分（HFRS）、住院时间（LOS）]进行多水平回归。结果：13815名参与者（51.1%为男性）的中位（IQR）年龄为77（71-84）岁。入院时中位用药数为5(2-9)，出院时中位用药数为9（6-13）。中位AUC DBI/天为0.13（0-0.5）。入院药物的数量与谵妄[调整比值比（aOR） 1.02, 95% CI: 1.01-1.04]、ADEs （aOR 1.03, 95% CI: 1.01-1.04）、压疮（aOR 1.04, 95% CI:1.02-1.06）、HFRS[调整比值比（aRR） 1.01, 95% CI:1.001-1.02]和LOS升高（aRR 1.011, 95% CI: 1.008-1.014）相关。AUC DBI/天与跌倒（aOR 1.29, 95% CI: 1.18-1.41）、谵妄（aOR 1.63, 95% CI:1.46-1.82）、ADEs （aOR 1.26, 95% CI: 1.11-1.43）、压疮（aOR 1.60, 95% CI: 1.38-1.86）、HFRS （aRR 1.27, 95% CI:1.17-1.37）和LOS增加（aRR 1.36, 95% CI:1.32-1.40）相关。结论：老年外科住院患者多药并存，且从入院到出院用药数量呈增加趋势。DBI暴露增加与不良结果相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Age and ageing 医学-老年医学

CiteScore

9.20

自引率

6.00%

发文量

796

审稿时长

4-8 weeks

期刊介绍： Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.