title: Inappropriate medication use in older adults undergoing surgery: a national study.
abstract: OBJECTIVE
  To determine the prevalence and factors associated with use of potentially inappropriate medications (PIMs) in older adults undergoing surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Three hundred seventy-nine acute care hospitals participating in the nationally representative Perspective database (2006-2008).
  
  
  METHODS
  Individuals aged 65 and older undergoing major inpatient gastrointestinal, gynecological, urological, and orthopedic surgery (N=272,351).
  
  
  METHODS
  Medications were classified as PIMs using previously published criteria defining 33 medications deemed potentially inappropriate in people aged 65 and older. Information about participant and provider characteristics and administration of PIMs was obtained from hospital discharge file data. Logistic regression techniques were used to examine factors associated with use of PIMs in the perioperative period.
  
  
  RESULTS
  One-quarter of participants received at least one PIM during their surgical admission. Meperidine was the most frequently prescribed PIM (37,855, 14% of participants). In adjusted analysis, PIM use was less likely as age advanced (adjusted odds ratio (AOR)=0.98 per year of age, 95% confidence interval (CI)=0.97-0.98) and in men (AOR=0.83, 95% CI=0.81-0.85). PIMs were more likely to be prescribed to participants cared for by orthopedic surgeons than for those cared for by general surgeons (AOR=1.22, 95% CI=1.08-1.40). Participants undergoing surgery in the West (AOR=1.79, 95% CI=1.02-3.16) and South (AOR=2.24, 95% CI=1.38-3.64) were more likely to receive a PIM than those in the Northeast.
  
  
  CONCLUSIONS
  Receipt of PIMs in older adults undergoing surgery is common and varies widely between providers and geographic regions and according to participant characteristics. Interventions aimed at reducing the use of PIMs in the perioperative period should be considered in quality improvement efforts.
authors: Department of Surgery, University of California, San Francisco, CA, USA. emily.finlayson@ucsfmedctr.org
authors: Emily
authors: E
authors: Finlayson
authors: Judith
authors: J
authors: Maselli
authors: Michael A
authors: MA
authors: Steinman
authors: Michael B
authors: MB
authors: Rothberg
authors: Peter K
authors: PK
authors: Lindenauer
authors: Andrew D
authors: AD
authors: Auerbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007297:Inpatients; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017751:Safety Management / Q000379:methods*; D013514:Surgical Procedures, Operative; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*