围术期老年患者潜在不适当用药与术后并发症关联性研究

doi:10.19803/j.1672-8629.20260218

摘要/Abstract

摘要： 目的分析围术期潜在不适当用药（Potentially Inappropriate Medications,PIMs）暴露水平与术后并发症的关联,为老年外科精准用药干预及手术质量管理优化提供参考。方法收集南京某医院2022年12月31日至2025年3月31日≥65岁非心脏择期手术的老年患者,采用单中心回顾性队列设计,基于Beers标准系统评估围术期PIMs并建立短期暴露评价指标;研究结局为术后30 d内并发症发生情况。采用多因素Logistic回归分析术前与术中PIMs的暴露对术后并发症风险的影响。结果研究共纳入696例患者,术前未发生PIMs 412例（59.20%）,术前存在PIMs暴露者284例（40.80%）;154例（22.13%）患者术后30 d内发生并发症。多因素Logistic回归分析显示,术前PIMs暴露是诱发术后药品不良反应的重要影响因素[比值比（Odds Ratio, OR）=1.651,P=0.019],且其暴露水平的升高亦与术后总体并发症风险的递增有关（OR=1.277,P=0.012）;238例（34.20%）患者于术前、术中均存在PIMs暴露。交互作用分析结果表明,术前-术中PIMs的叠加暴露对术后并发症风险具有协同增强效应,其影响显著高于任意时期的单独暴露效应（OR=6.585,P=0.003）。结论老年患者术前PIMs暴露较为常见,且与术后并发症风险增加相关;若叠加术中PIMs的额外暴露,可进一步加剧对术后康复的负面影响。推进围术期PIMs的常规化、动态化监测有助于预后风险分层,并可成为改善术后转归的潜在干预靶点。

关键词: 潜在不适当用药, 围术期, 术后并发症, 单中心回顾性队列, 老年患者

Abstract: Objective To analyze the association between perioperative PIM exposure levels and postoperative complications in order to provide evidence for decision-making regarding precise medication interventions and optimization of surgical quality management in elderly patients. Methods A single-center retrospective cohort design was employed. Patients ages 65 and older undergoing elective non-cardiac surgery at a hospital in Nanjing between December 2022 and March 2025 were included. Perioperative PIMs were evaluated based on the Beers criteria, and short-term exposure evaluation indicators were established. The outcome referred to the occurrence of complications within 30 days postoperatively. Multivariable logistic regression analysis was conducted to examine the impact of preoperative and intraoperative PIM exposure on the risk of postoperative complications. Results A total of 696 patients were enrolled in this study, 284 of whom (40.80%) were exposed to PIMs preoperatively. Postoperative complications within 30 days occurred in 154 patients (22.13%) of the entire cohort. Multivariable logistic regression analysis found that preoperative PIM exposure was a significant contributor to postoperative adverse drug reactions [Odds Ratio (OR)=1.651, P=0.019]. An increase in preoperative PIM exposure levels was associated with an incremental risk of overall postoperative complications (OR=1.277, P=0.012). In addition, 238 patients (34.20%) were exposed to PIMs both preoperatively and intraoperatively. Interaction analysis indicated that combined preoperative-intraoperative PIM exposure had a synergistic effect on the risk of postoperative complications, with a more significant impact than exposure during either period alone (OR=6.585, P= 0.003). Conclusion Preoperative PIM exposure is common among elderly surgical patients and associated with an increased risk of postoperative complications. Additional intraoperative PIM exposure can exacerbate the negative impact on postoperative recovery. Routine and dynamic monitoring of perioperative PIMs is conducive to prognostic risk stratifi-cation and may serve as a potential intervention target for improving postoperative outcomes.

Key words: Potentially Inappropriate Medication, Perio-perative Period, Postoperative Complications, Single-Center Retrospective Cohort Design, Elder Patients

中图分类号:

R994.11

徐玲, 李佳婕, 李歆, 顾凯. 围术期老年患者潜在不适当用药与术后并发症关联性研究[J]. 中国药物警戒, 2026, 23(7): 802-808.

Xu Ling, Li Jiajie, Li Xin, Gu Kai. Association between perioperative potentially inappropriate medication and short-term adverse postoperative outcomes in elderly patients[J]. Chinese Journal of Pharmacovigilance, 2026, 23(7): 802-808.

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