B54-28 Preoperative Polypharmacy and Postoperative Outcomes in Surgical Patients Aged Ninety Years and Older

Rationale Polypharmacy—commonly defined as the concurrent use of five or more medications—is highly prevalent in older adults and has been associated with adverse outcomes such as falls, functional decline, and hospitalization (1). However, its impact on postoperative outcomes among surgical nonagenarians remains unclear. As this population continues to grow, understanding the perioperative risks associated with polypharmacy is essential to guide clinical decision-making and geriatric anesthesia planning. This study aimed to evaluate the association between preoperative polypharmacy and postoperative complications, delirium, readmissions, and mortality in patients aged 90 years or older undergoing surgery. Methods A retrospective cohort study was conducted using a multicenter surgical database in Colombia. Patients aged ≥90 years who underwent any surgical procedure between January 2020 and December 2024 were included. Polypharmacy was defined as the use of five or more chronic medications at hospital admission. Primary outcomes included postoperative complications, in-hospital delirium, 30-day readmission, and in-hospital mortality. Comparative analyses were performed between patients with and without polypharmacy using descriptive and univariate methods. Statistical significance was defined as p < 0.05. Results A total of 206 patients were analyzed (mean age 92.3 ± 2.5 years; 64% female), of whom 35.4% (n = 73) met criteria for polypharmacy. Delirium occurred in 13.6% of all patients, with no significant difference between groups. Those with polypharmacy exhibited slightly higher rates of postoperative complications (23.3%), 30-day readmission (15.5%), and in-hospital mortality (6.3%) compared with those without polypharmacy; however, these differences were not statistically significant in unadjusted comparisons. Although polypharmacy was common, it did not independently predict adverse postoperative outcomes in this very elderly surgical cohort. Conclusions Preoperative polypharmacy was frequent among surgical nonagenarians but did not demonstrate a clear independent association with early postoperative complications, delirium, or mortality. Although a trend toward higher adverse outcomes was observed in patients with polypharmacy, this association did not reach statistical significance—likely due to the limited sample size and low event rate. Future studies with larger populations are warranted to confirm these findings and should incorporate measures of medication appropriateness, frailty indices, and cognitive function into comprehensive risk prediction tools to optimize perioperative care for this high-risk group. REFERENCES: 1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in the elderly. Expert Opin Drug Saf.2014;13(1):57-65.