Evaluating the impact of polypharmacy in elderly patients undergoing neurosurgery: a retrospective study

OBJECTIVES: This study aimed to evaluate the impact of polypharmacy on length of hospital stay (LOS) and occurrence of postoperative complications in elderly patients undergoing neurosurgery. METHODS: This study represents a single-centre retrospective review of consecutive patients above 65 years old undergoing elective or emergency neurosurgery between June 2021 and January 2022. Patients were categorised into two groups based on the presence (five or more medications) or absence of polypharmacy. Chi-Square and/or Fisher exact test were used to compare baseline characteristics between groups and Mann-Whitney U test for continuous non-normally distributed variables. Multiple logistic regression models were constructed using significant variables affecting LOS and postoperative complications with adjusted Odds Ratios and 95% CIs reported. RESULTS: In total 499 patients over the age of 65 underwent emergency or elective neurosurgery, and 218 (43%) met the criteria for polypharmacy. The polypharmacy group had a higher median LOS than the non-polypharmacy cohort (6 days vs. 5 days, p = 0.005). Polypharmacy was also associated with increased likelihood of postoperative complications (OR 1.62, CI 1.05-2.50, p = 0.02). CONCLUSION: Our findings highlight the need for considered medication review in the perioperative period to support elderly patients undergoing neurosurgery for better postsurgical outcomes.