Background and importance In order to ensure the efficacy and safety of a prescribed drug regimen during cardiac surgery, a standardised preoperative management strategy is needed in routine care. However, data are lacking on how many drugs need preoperative management and which strategies are effective in routine care.
Aim and objectives To investigate the overall need of preoperative medication management in cardiac surgery patients and to determine the efficacy of an interprofessional preoperative medication management bundle in routine care.
Material and methods An interprofessional cooperation of cardiac surgeons and hospital pharmacists developed an evidence-based preoperative medication management standard for the most common drugs (eg, oral anticoagulants, antidiabetics, etc.) which was subsequently implemented in clinical routine. Briefly, the standard was included in the admission letter for the primary care physician, sent to the referring hospitals, distributed as a pocket card to the physicians, and an interprofessional hotline for inquiries was made available. Before and after implementation, the timepoints of the last preoperative drug intake were assessed by pharmacists and cardiac surgeons according to the determined standard in two samples of consecutively admitted patients (except emergencies). The study was approved by the local ethics committee.
Results Before implementation, 222 of 273 included patients (78.7%) were admitted to surgery with at least one drug that needed active preoperative management according to the defined standard. Management was deemed correct for 30.0% of direct oral anticoagulants (DOAC) (n=52), 28.2% of metformin (n=39), 15.5% of sodium-glucose transporter II (SLGT-2) inhibitors (n=19) and 78.9% of prophylactic platelet inhibitors (n=142). Six months after implementation, 249 of 290 patients (85.9%) had at least one drug that needed to be perioperatively addressed. The number of correctly managed drugs increased for DOAC to 68.4% (n=57) and to 96.4% for platelet inhibitors in prophylaxis (n=167), but only slightly for metformin (n= 36) to 44.4% and to 24.0% for SLGT-2 inhibitors (n= 25).
Conclusion and relevance The standardised preoperative management bundle effectively improved perioperative drug therapy; however, the results indicate that there is potential for further improvement, especially in patients referred from other hospitals.
Conflict of interest No conflict of interest