Background and importance Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution for elderly patients due to the high risk of gastrointestinal and renal adverse effects (AE). However, this drug class is widely used in the perioperative period for their analgesic properties, to spare using opioids. Due to serious AE imputed by pharmacovigilance in Orthopedic Surgery Departments (OSD), a study of NSAIDs prescriptions was conducted in this care unit. Clinical pharmacy development in OSD highlighted dysfunctions in prescribing NSAIDs for patients aged over 75 years who are at high risk of AE.
Aim and objectives To quantify how commonly postoperative prescription of NSAIDs are used and to assess the risks associated for patients aged over 75 years in OSD.
Material and methods We performed a retrospective, observational study between January and October 2021 on all NSAIDs prescriptions for patients aged over 75 years in OSD. Treatments which may cause renal failure in elderly patients (angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARB), diuretics) were noted. Specific attention was given to patients having presented a serious AE including a declaration to pharmacovigilance.
Results In total, 584 patients received NSAIDs in the OSD. 80 patients were aged over 75 years (13.7%), of which 21 patients were taking ACE inhibitors (26%) at the same time, 17 patients an ARB (21%) and 13 patients diuretics (16%). A combination of three nephrotoxic drugs was found for 2 patients and a combination of two for 20 patients. The median creatinine before surgery was 69 µM (40–141 µM) and median renal clearance was 78 mL/min. Serious renal AE were identified in 5 patients (6.25%) leading to prolonged hospitalisation and haemodialysis for one patient. AE were present within 48 hours of taking NSAIDs. No other AE were detected.
Conclusion and relevance The inappropriate prescriptions of NSAIDs observed in elderly patient and their association with other potentially nephrotoxic drugs increases the risk of renal AE. The actions implemented initially were setting analgesic protocols adapted to the patient’s age according to the latest recommendations. Secondly, both pharmaceutical and medical prescriptions were being monitored daily. Since surgery involves several prescribers (anaesthesiologists, surgeons, doctors), harmonising prescription practices is currently being considered.
Conflict of interest No conflict of interest