L Castanheira1, P Fresco, A F Macedo. 1. Health Sciences Research Centre, University of Beira Interior, Covilhã Pharmacology Department, Pharmacy Faculty, Oporto University, Porto, Portugal. lcastanheira@fcsaude.ubi.pt
Abstract
WHAT IS KNOWN AND OBJECTIVE: The worldwide volume of surgery is huge and the number of interventions performed is increasing as a result of advances in technological resources and refinement of medical teams' expertise, in a progressively elderly and sick population. Consequently, half of the general surgical patients take medications unrelated to surgery. Evidence-based guidelines for perioperative medication management are therefore critically needed to improve safety in surgery. The purpose of this work was to develop practice recommendations for the management of chronic medication in the perioperative period. METHODS: A systematic review and a formal consensus were performed. A search in Medline, Embase, ISI Web of Knowledge and Medscape were conducted in September 2008. Two independent investigators assessed the quality of selected studies. Evidence-based guidelines with strength classification were found for some therapeutic groups. Those guidelines were adopted and no further analysis was performed. For the other therapeutic groups, a formal consensus was used, based on a modified nominal group technique: 32 statements were formulated considering the literature retrieved. A selected panel of experts was asked by electronic mail to rate their level of agreement with each statement. Then, a meeting was convened and a second round survey was used to determine the final level of agreement. The statements which met the established criteria of consensus were developed into practice recommendations, supported by the results of the formal consensus and the evidence-based findings from systematic review. RESULTS AND DISCUSSION: A total of 23 studies were included in the systematic review; three randomized controlled trials (RCTs), 13 cohorts, two case-controls and three clinic-cases. Twenty-two practice recommendations for the management of chronic medication in the perioperative period resulted from formal consensus. WHAT IS NEW AND CONCLUSION: Epidemiological studies concerning the perioperative management of chronic medications are clinically heterogeneous and there are few RCTs available. However, the formal consensus method proved to be a helpful tool to integrate different strands of evidence for the development of practice guidelines.
WHAT IS KNOWN AND OBJECTIVE: The worldwide volume of surgery is huge and the number of interventions performed is increasing as a result of advances in technological resources and refinement of medical teams' expertise, in a progressively elderly and sick population. Consequently, half of the general surgical patients take medications unrelated to surgery. Evidence-based guidelines for perioperative medication management are therefore critically needed to improve safety in surgery. The purpose of this work was to develop practice recommendations for the management of chronic medication in the perioperative period. METHODS: A systematic review and a formal consensus were performed. A search in Medline, Embase, ISI Web of Knowledge and Medscape were conducted in September 2008. Two independent investigators assessed the quality of selected studies. Evidence-based guidelines with strength classification were found for some therapeutic groups. Those guidelines were adopted and no further analysis was performed. For the other therapeutic groups, a formal consensus was used, based on a modified nominal group technique: 32 statements were formulated considering the literature retrieved. A selected panel of experts was asked by electronic mail to rate their level of agreement with each statement. Then, a meeting was convened and a second round survey was used to determine the final level of agreement. The statements which met the established criteria of consensus were developed into practice recommendations, supported by the results of the formal consensus and the evidence-based findings from systematic review. RESULTS AND DISCUSSION: A total of 23 studies were included in the systematic review; three randomized controlled trials (RCTs), 13 cohorts, two case-controls and three clinic-cases. Twenty-two practice recommendations for the management of chronic medication in the perioperative period resulted from formal consensus. WHAT IS NEW AND CONCLUSION: Epidemiological studies concerning the perioperative management of chronic medications are clinically heterogeneous and there are few RCTs available. However, the formal consensus method proved to be a helpful tool to integrate different strands of evidence for the development of practice guidelines.
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