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

Abstract

We 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. Older 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. Among 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. This 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.