# Medication Reconciliation in the Surgical Setting: A Cross-Sectional Study in Polymedicated Patients

## TL;DR

This study found that many surgical patients on multiple medications had significant and potentially dangerous medication discrepancies during the perioperative period.

## Contribution

The study identifies the high frequency of clinically relevant medication discrepancies in polymedicated surgical patients and highlights gaps in pre-anesthesia documentation.

## Key findings

- 86% of medications had discrepancies, with 44% classified as real discrepancies, mainly due to unjustified omission.
- 36.8% of real discrepancies had potential clinical severity, including cases of asthma exacerbation and hypertensive crises.
- 73% of pre-anesthesia reports lacked specific recommendations for managing chronic medications.

## Abstract

Objectives: This study aimed to assess the incidence, nature, and clinical relevance of medication discrepancies identified during the perioperative period in polymedicated surgical patients, and to examine factors associated with the occurrence of real discrepancies. Methods: A cross-sectional study was conducted in scheduled surgical patients admitted to the General Surgery department of a tertiary-care hospital. Eligible adults were required to be taking ≥4 chronic medications, have restored oral tolerance, and remain hospitalized for more than 48 h. Medication reconciliation was performed using hospital and primary care electronic records, complemented by a structured patient interview. Discrepancies were classified as justified or real according to SEFH criteria. Statistical analysis included descriptive methods, normality testing, correlation analyses, and generalized linear models. Results: Out of 270 assessed patients, 43 met inclusion criteria. A total of 282 medications were analyzed, with 243 (86%) showing discrepancies. 44% were real discrepancies, primarily due to unjustified omission. The average number of real discrepancies per patient was 5.7 (95% CI: 4.8–6.5). Cardiovascular (35.2%) and nervous system drugs (23.2%) were most affected. Real discrepancies with potential clinical severity accounted for 36.8%, including cases of asthma exacerbation, withdrawal syndromes, insomnia, and hypertensive crises. In 73% of pre-anesthesia reports, no specific recommendations regarding chronic medication management were provided. Conclusions: Medication reconciliation revealed frequent and clinically relevant discrepancies in this high-risk cohort of polymedicated surgical patients. Larger, more representative studies are needed to confirm these findings and to inform broader perioperative safety strategies.