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Letters to the Editor
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Preoperative association
Take demographics and selection criteria into account
From Mrs C. M. Dixon, MRPharmS
I was pleased to see an account of the first National
Preoperative Association Conference (PJ, 6 November, p693); it is a promising start for greater
liaison in this field.
One sentence which stood out was the statement that an estimated 25 per
cent of patients requiring elective surgery are on medicines for other
conditions. That is not the experience at this centre.
I have looked at our records for 100 consecutive patients admitted between
4 and 18 October. Ninety-six of these had hip or knee replacements; the
other four had cruciate ligament repairs. Demographics are 7 per cent
aged less than 50 years; 47 per cent aged 70–79 and 20 per cent
aged 80 or over.
Eight per cent of these patients had no medicines from their GP, but
were using purchased analgesics. Fourteen per cent had prescribed analgesics
or non steroidal anti-inflammatory drugs or both. This leaves 78 per
cent taking prescribed medicines for other conditions. Of these, 46 per
cent were on three or more additional items, including three patients
on 10 or more items (one on 16). Some of these patients had multiple
conditions, eg, hypertension plus chronic obstructive pulmonary disease
plus diabetes.
Many elective surgical units only accept patients of American Society
of Anesthesiologists grade 1 or 2, ie, fit, low-risk patients. This centre
accepts patients regardless of ASA grade, hence the difference. Any pharmacy
manager where a new unit is being planned would be well advised to check
the proposed patient demographics and selection criteria when estimating
workload.
Christine Dixon
Principal Pharmacist,
S W London Elective Orthopaedic Centre
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Pharmaceutical Journal