Implications of Polypharmacy to Clinical Practice for Traumatic Spinal Cord Injury: A Population-Based Approach in...

Patients living with traumatic spinal cord injury (TSCI) often have multiple medical issues and chronic pain requiring potentially several prescription medications. Taking multiple medications can lead to adverse side effects and drug interactions. The main objective of this study is to measure polypharmacy among TSCI patients over a 20-year period and evaluate associated injury characteristics and clinical factors. This study is a retrospective analysis of a population-based cohort of patients with TSCI between 2001 and 2022. Utilizing linked health care data, patients with TSCI were identified. All community-dispensed medications were identified during the first 365 days after discharge. The cumulative polypharmacy method was utilized (average of ≥5 medications over four quarters of the year). Summary statistics were used to evaluate rates of polypharmacy. A multivariable logistic regression identified demographic and clinical characteristics associated with polypharmacy. A total of 3142 patients were identified, 964 (30.7%) patients had polypharmacy with ≥5 medications averaged per quarter in a 1-year period after discharge from the hospital. Factors associated with polypharmacy were age 65 and older (OR = 3.1, p < 0.001), female (OR = 1.5, p < 0.001), and a higher pre-existing comorbidity burden (OR = 3.8, p = 0.030). The study found that it is common for patients to experience polypharmacy in the first year after their injury. While polypharmacy is not inherently harmful, patients with polypharmacy should be identified and closely monitored for unnecessary medications, and policymakers should evaluate the role of regular medication reviews to avoid complications and poor outcomes.