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Meta-Analysis
. 2015 Apr;79(4):548-57.
doi: 10.1111/bcp.12504.

An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients

Eveline B Boeker  1 , Kim Ram, Joanna E Klopotowska, Monica de Boer, Montse Tuset Creus, Ana L de Andrés, Mio Sakuma, Takeshi Morimoto, Marja A Boermeester, Marcel G W Dijkgraaf
Affiliations
Meta-Analysis

An individual patient data meta-analysis on factors associated with adverse drug events in surgical and non-surgical inpatients

Eveline B Boeker et al. Br J Clin Pharmacol. 2015 Apr.

Abstract

Aim: The incidence of adverse drug events (ADEs) in surgical and non-surgical patients may differ. This individual patient data meta-analysis (IPDMA) identifies patient characteristics and types of medication most associated with patients experiencing ADEs and suggests target areas for reducing harm and implementing focused interventions.

Methods: Authors of eligible studies on preventable ADEs (pADEs) were approached for collaboration. For assessment of differences among (non-)surgical patients and identification of associated factors descriptive statistics, Pearson chi-square, Poisson and logistic regression analyses were performed. For identification of high risk drugs (HRDs), a model was developed based on frequency, severity and preventability of medication related to ADEs.

Results: Included were 5367 patients from four studies. Patients aged ≥ 77 years experienced more ADEs and pADEs compared with patients aged ≤ 52 years (odds ratios (OR) 2.12 (95% CI 1.70, 2.65) and 2.55 (95% CI 1.70, 3.84), respectively, both P < 0.05). Polypharmacy on admission also increased the risk of ADEs (OR 1.21 (95% CI 1.03, 1.44), P < 0.05) and pADEs (OR 1.85 (95% CI 1.34, 2.56), P < 0.05). pADEs were associated with more severe harm than non-preventable ADEs (54% vs. 32%, P < 0.05). The top five HRDs were antibiotics, sedatives, anticoagulants, diuretics and antihypertensives. Events associated with HRDs included diarrhoea or constipation, abnormal liver function test and central nervous system events. Most pADEs resulted from prescribing errors (90%).

Conclusion: Elderly patients with polypharmacy on admission and receiving antibiotics, sedatives, anticoagulants, diuretics or antihypertensives were more prone to experiencing ADEs. Efficiency in prevention of ADEs may be improved by targeted vigilance systems for alertness of physicians and pharmacists.

Keywords: adverse drug events; epidemiology; medication safety; non-surgical patient; surgical patient.

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