Study says stopping medication before surgery can be dangerous

According to an editorial published in the British Medical Journal (vol. 321, no. 7263), discontinuing medication before surgery can actually increase the risk of complications. The authors of the editorial, David Noble and Henrik Kehlet, cite an observational study of 1,000 admissions for general and vascular surgery that found that "a high number of patients scheduled for inpatient surgery took therapeutic drugs; that there was a higher incidence of perioperative complications among patients who took such drugs; and that there was significant association between abstinence from therapeutic drugs and adverse outcomes."

The study found that the overall complication rate for patients whose cardiovascular medicine was interrupted for less than two days was 12%. However, for those whose medicine was interrupted for two days or more, the figure jumped to 27%.

"Although reducing or abstaining from the use of recreational drugs, such as alcohol, and a small number of therapeutic drugs, such as oral anticoagulants, may be desirable before surgery, the abrupt discontinuation of most drugs is unlikely to be of any benefit," the authors wrote.

Noble and Kehlet offered three solutions to the problems that can be caused by abstaining from therapeutic drugs before surgery:

•Â Allow patients to continue their drug regimens until the day of surgery.

•Â Use alternatives to the oral route of administration when possible, at least until the oral route can be reestablished.

•Â Where alternative routes are not available, alternate drugs of the same or different class that can be administered through non-oral routes should be used.

"Although increased awareness and careful planning by clinicians will help reduce the adverse effects of abruptly discontinuing drugs in the postoperative period, other action is needed," the authors wrote. "The problem of abrupt drug discontinuation is not sufficiently recognized by the pharmaceutical industry, agencies that give advice on drugs or regulatory agencies." PR