Possible negative impact of polypharmacy on surgical outcomes in older patients with lumbar spinal stenosis

Older patients with lumbar spinal stenosis (LSS) have a higher incidence of polypharmacy attributed to comorbidities and the use of pain relief medications. This study aimed to explore the effect of polypharmacy and hyperpolypharmacy on surgical outcomes in older patients with LSS based on health-related quality of life (HRQOL) and locomotive syndrome.

Consecutive patients aged ≥65 years who underwent lumbar spinal surgery for LSS were retrospectively reviewed. We assessed the preoperative and 1- and 2-year postoperative scores of three common HRQOL tools and the 25-question Geriatric Locomotive Function Scale. The patients were classified into the hyperpolypharmacy group (those taking ≥10 medications), polypharmacy group (those taking 6-9 medications) and non-polypharmacy group (those taking ≤5 medications).

In total, 148 participants were evaluated. Among them, 35 were included in the non-polypharmacy group. There were no significant changes in the HRQOL and locomotive syndrome stage at baseline, even with polypharmacy progression. However, the HRQOL and locomotive syndrome stage worsened postoperatively with polypharmacy progression. When surgical efficacy was directly examined, results showed that the surgical outcomes were significantly associated with polypharmacy progression in older patients with LSS, even after adjusting for potential confounders.

Polypharmacy, especially hyperpolypharmacy, had a negative impact on surgical outcomes in older patients with LSS. The number of prescription drugs should be taken into consideration before surgery in this patient group. Geriatr Gerontol Int 2025; 25: 31-37.