Polypharmacy in geriatric patients undergoing surgery-strategies to reduce the risk of iatrogenic events

As the elderly population is increasing globally, more and more geriatric patients are expected to undergo surgical interventions. With age, the incidence of comorbidities is also higher, with these patients being in a significant proportion subject to polypharmacy. The present paper is a comprehensive review of the prevalence, cause, and specific risks associated with polypharmacy in the elderly undergoing elective surgical procedures. The possible implications on hospital stay, perioperative morbidity, and healthcare expenditure and the strategies to minimize the risk of adverse events in the perioperative course due to polypharmacy are presented. Polypharmacy has a high prevalence in older patients and can be attributed to multiple patient and doctor-related causes. Adverse drug reactions are significantly associated with the number of personal medications and represent an avoidable cause of perioperative morbidity. The most frequent polypharmacy complications are falls, cardiac events, hemorrhages, postoperative cognitive impairment, and delirium. Preoperative polypharmacy management in geriatric patients should include a comprehensive medication review and a multidisciplinary approach. Further directions of study include strategies for deprescribing and implementing software tools to assess inappropriate drug associations and help clinicians minimize the risk of drug interactions.