Preoperative polypharmacy assessment for risk stratification and management

Perioperative medicine is a rapidly expanding multidisciplinary model of care designed to comprehensively assess a wide range of patient domains to minimise the risk of preoperative, intraoperative, and postoperative complications.1 There is increasing evidence that such presurgical assessments are beneficial for risk stratification, particularly in older adults, a highly heterogeneous group that is often characterised by a reduced homeostatic capacity.2, 3 For example, the preoperative identification of frailty, a process that requires adequate staff resources and time given the multidimensional nature of the assessment, has been shown to predict postsurgery delirium, falls, infections, prolonged hospitalization, and mortality.4, 5 However, critical issues arising from these observations are (a) whether anything else can be done in the frail older patient awaiting surgery, apart from selecting the most appropriate anaesthetic protocol, surgical procedure, and rehabilitation plan and (b) whether the presence and the severity of frailty can be identified using alternative, more straightforward, tools. The assessment of polypharmacy, the concomitant use of multiple medicines in a patient, can be helpful in this setting because of the intricate, yet increasingly recognised, associations between polypharmacy, frailty, and adverse outcomes in older patients.6, 7 The latter, notably, can often manifest as functional and/or cognitive decline, with consequent loss of independence, and be erroneously confused with the process of advancing age per se.8