Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits

Jonathan S Lee; Ralph Gonzales; Eric Vittinghoff; Kitty K Corbett; Kirsten E Fleischmann; Neil Sehgal; Andrew D Auerbach

doi:10.12788/jhm.2808

Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits

J Hosp Med. 2017 Sep;12(9):723-730. doi: 10.12788/jhm.2808.

Authors

Jonathan S Lee¹, Ralph Gonzales², Eric Vittinghoff³, Kitty K Corbett⁴, Kirsten E Fleischmann⁵, Neil Sehgal⁶, Andrew D Auerbach⁶

Affiliations

¹ Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA. jonathan.lee2@ucsf.edu.
² Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
⁴ School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
⁵ Division of Cardiology, University of California San Francisco, San Francisco, California, USA.
⁶ Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA.

PMID: 28914276
DOI: 10.12788/jhm.2808

Abstract

Objective: To describe appropriate discharge reconciliation of cardiovascular medications and assess associations with postdischarge healthcare utilization in surgical patients.

Design: Retrospective cohort study from January 2007 to December 2011.

Setting: An academic medical center.

Patients: Seven hundred and fifty-two adults undergoing elective noncardiac surgery and taking antiplatelet agents, beta-blockers, renin-angiotensin system inhibitors, or statin lipid-lowering agents before surgery.

Measurements: Primary predictor: appropriate discharge reconciliation of preoperative cardiovascular medications (continuation without documented contraindications). Primary outcomes: acute hospital visits (emergency department visits or hospitalizations) and unplanned ambulatory visits (primary care or surgical) at 30 days after surgery.

Results: Preoperative medications were appropriately reconciled in 436 (58.0%) patients. For individual medications, appropriate discharge reconciliation occurred for 156 of the 327 patients on antiplatelet agents (47.7%), 507 of the 624 patients on beta-blockers (81.3%), 259 of the 361 patients on renin-angiotensin system inhibitors (71.8%), and 302 of the 406 patients on statins (74.4%). In multivariable analyses, appropriate reconciliation of all preoperative medications was not associated with acute hospital (adjusted odds ratio [AOR], 0.94; 95% confidence interval [CI], 0.63-1.41) or unplanned ambulatory visits (AOR, 1.48; 95% CI, 0.94-2.35). Appropriate reconciliation of statin therapy was associated with lower odds of acute hospital visits (AOR, 0.47; 95% CI, 0.26-0.85). There were no other statistically significant associations between appropriate reconciliation of individual medications and either outcome.

Conclusions: Although large gaps in appropriate discharge reconciliation of chronic cardiovascular medications were common in patients undergoing elective surgery, these gaps were not consistently associated with postdischarge acute hospital or ambulatory visits.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Cardiovascular Diseases / drug therapy
Elective Surgical Procedures*
Female
Hospitalization
Humans
Male
Medication Reconciliation*
Middle Aged
Patient Discharge / standards
Patient Discharge / statistics & numerical data*
Pharmaceutical Preparations / administration & dosage
Primary Health Care*
Retrospective Studies
Risk Factors

Substances

Pharmaceutical Preparations