Thực trạng quản lý thuốc điều trị bệnh mạn tính trước phẫu thuật ở người bệnh phẫu thuật theo chương trình tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To describe the current practice of obtaining and documenting medication histories, medication continuation, and the appropriateness of perioperative management decisions for chronic medications among patients undergoing elective surgery at 108 Military Central Hospital. Ssubject and method: A cross-sectional analytical study was conducted in November 2025 at the Institute of Gastrointestinal Surgery and the Institute of Orthopedic Surgery, 108 Military Central Hospital. The study included hospitalized patients aged ≥18 years who were scheduled for elective surgery and had been taking at least one chronic medication prior to hospital admission. The Best Possible Medication History (BPMH) was established through patient and/or caregiver interviews, combined with a review of medical records and other relevant information sources. The appropriateness of preoperative medication management decisions was assessed using a standardized set of criteria developed based on current professional guidelines and recommendations. Result: A total of 286 patients were included in the analysis, with a median age of 69 years (range, 28–93), and 58.7% were male. Overall, 1,280 chronic medications were identified, with a mean of 4.5 medications per patient. Although medication history was obtained for all patients, only 75.2% had their medication history documented in the medical record, and only 31.0% of chronic medications were fully documented. Overall, 49.0% of chronic medications were not continued in inpatient medication orders, while 88.1% of patients had at least one chronic medication that was not continued, with a mean of 3.09 ± 1.83 non-continued medications per patient. Among the 653 chronic medications with documented physician preoperative management decisions, only 326 (49.9%) were judged to be managed appropriately according to the standardized assessment tool, and 95.8% of patients had at least one medication with an inappropriate preoperative management decision. Conclusion: The management of chronic medications in the preoperative period at 108 Military Central Hospital remains suboptimal. Medication history was documented in the medical records for 75.2% of patients, while only 31.0% of medication records were fully documented. Overall, 49.0% of medications were not continued in the preoperative medication orders; 88.1% of patients had at least one medication that was not continued, with a mean of 3.09 ± 1.83 medications not continued per patient. According to the standardized assessment tool, 49.9% of medication management decisions were considered appropriate before surgery, while 95.8% of patients had at least one medication management decision that was considered inappropriate.