Systemized Nomenclature of Medicine Clinical Terms for the structured expression of perioperative medication management recommendations

With an aging U.S. population,1 there has been progressive growth in the number of surgeries, surgery-related costs, and complications of surgery.2,–5 At least 50% of patients undergoing surgery take medications on a regular basis,6 and as many as 44% take medications in preparation for surgery.7 Furthermore, half of general surgical patients take medications unrelated to surgery and are thus at increased risk for postoperative complications relative to patients taking no medications.6 Recommendations for perioperative medication management (PMM)—decisions on stopping or continuing a patient’s active medications during a preoperative physical examination—are largely provider specific, nonstandard, and written in free-text format. In the study described in this article, we aimed to evaluate the use of standard medical terminology instead of the free-text format for conveying PMM recommendations. Managing a patient’s active medications during the perioperative period is a complex clinical problem. The state of the underlying disease, the risk of withdrawing medications, the patient’s response to stresses of surgery, the patient’s comorbidities, and drug–anesthesia interactions are all factors that the provider needs to consider in making each medication recommendation.8,9 While the surgical procedural burden in the United States is increasing, some providers feel that they are inadequately trained to perform preoperative evaluations because, until recently, most of the perioperative literature was published in a variety of specialty journals. Only in the last few years has more information appeared in the general medical literature.10 It has been shown that good medication management can improve postoperative outcomes11 and plays a key part in successful and safe transitions of care12,–14 and in the prevention of adverse drug events.15