Editorial: The risks of interrupting drug treatment before surgery
Abruptly stopping drug treatments before surgery can be dangerous and increase the risk of postoperative complications, suggests an editorial in this week's BMJ.
Surgery, particularly major abdominal surgery, affects the rate at which stomach contents are emptied, so reducing the absorption of drugs. Patients may therefore have to wait several days before they can resume their normal medical routine.
Noble and Kehlet cite research showing a significantly increased risk of adverse outcomes among patients whose drug regimens had been stopped before surgery. Patients taking therapeutic drugs that were unrelated to their surgery were three times as likely to have complications as those not taking medicines. And the longer the duration of abstinence, the higher was the complication rate.
Doctors need to ensure that drug treatments are resumed as soon as possible, write the authors, by providing alternative routes, medicines, and by reducing the need for opioid anaesthesia. But the pharmaceutical industry also needs to do more, they say. Guidance should be included in drug information leaftlets and in national drug formularies to help doctors provide alternative medicines and be aware of the symptoms associated with sudden withdrawal from treatment.
"Such is the scale of the problem that failing to prevent the consequences of drug withdrawal in the postoperative period should possibly be considered equivalent to those medication errors that have been called 'worse than a crime', " conclude the authors.
Contact:
Dr David Noble, Department of Anaesthesia, Intensive Care and Hyperbaric Medicine, Grampian University Hospitals, Aberdeen, Scotland
Email: david.noble@arh.grampian.scot.nhs.uk