Influence of Polypharmacy on Post-surgical Mortality in Elderly Adults With Hip Fracture

Purpose: Polypharmacy is a common problem in surgical patients with hip fractures. Their influence on the mortality is what we pretend to study, aiming to inform management strategies and reduce mortality risks. Methods: A retrospective study was conducted at Hospital de la Ribera, Alzira, targeting patients aged ≥70 who underwent hip fracture surgery in 2017 and 2018. Data were extracted from electronic medical records, including demographic details, comorbidities, and medication use. Polypharmacy was defined as the use of five or more medications. Mortality rates were analyzed at 30 days, 6 months, 1 year, 2 years, and 5 years post-surgery using Kaplan-Meier survival curves and Cox regression analysis. Results: Among 644 patients included, (mean age 84.5 years, 70.5%women), polypharmacy was present in 63.8%, and severe polypharmacy (≥10 medications) in 19.1% of patients. Polypharmacy significantly increased mortality at all time intervals: 30 days (10.6% severe polypharmacy vs 3.0% no polypharmacy, p=0.042), 6 months (22.7% vs 9.6%, p=0.003), 1 year (39.4% vs 11.9%, p<0.001), 2 years (51.5% vs 14.8%, p<0.001), and 5 years (76.2% vs 26.3%, p<0.001).It was also associated with higher rates of major complications and red cell transfusions. Hazard ratios for 5-year mortality were significantly elevated for patients on hypotensives, benzodiazepines, antidiabetics, opioids, neuroleptics, and anti-dementia drugs. Conclusion: Polypharmacy significantly impacts postoperative mortality and morbidity in elderly hip fracture patients. Effective management, including medication review and deprescribing strategies, is crucial to improving outcomes. Comprehensive geriatric assessments and interdisciplinary approaches are recommended to optimize treatment and reduce the adverse effects of polypharmacy.