Association of polypharmacy and perioperative outcomes: Systematic review and meta-analysis

Polypharmacy is becoming more prevalent due to an ageing population. As more patients are undergoing surgical procedures, it is important to determine which group of patients are at higher risk of poorer outcomes. This review aimed to provide a summary of existing literature and to determine if polypharmacy is associated with poorer perioperative outcomes and to identify any gaps in the literature. This systematic review was conducted using electronic databases PubMed, Embase and Web of Science from their inception to December 2024. Statistical analysis was performed using generic inverse variance method. We identified 45 eligible studies from different countries and different surgical populations. Thirty-two studies (71.11%) defined polypharmacy as the use of five or more medications. Polypharmacy is significantly associated with postoperative delirium (odds ratio = 1.62, 95% confidence interval = 1.32-1.98, I² = 0%). Although polypharmacy is found to be significantly associated with postoperative delirium, the relationship between polypharmacy and postoperative delirium remains complex.