Skip to main content
Erschienen in: International Journal of Clinical Pharmacy 4/2021

17.11.2020 | Research Article

Incident adverse drug reactions and their effect on the length of hospital stay in older inpatients

verfasst von: Tamara Sandoval, Matías Martínez, Fabián Miranda, Marcela Jirón

Erschienen in: International Journal of Clinical Pharmacy | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Background Acutely ill older persons are more likely to suffer adverse drug reactions, increasing morbidity, and mortality. The incident adverse drug reactions and their consequences on the length of hospital stay (LOS) in older persons have been little explored. Objective To determine the incident adverse drug reactions in acutely ill older inpatients and their effect on the LOS. Setting Internal medicine service in a Chilean teaching hospital. Method A prospective cohort study was conducted in patients aged ≥ 60 years admitted into the internal medicine service of the Hospital from University of Chile. Characteristics, severity, and causality of adverse drug reactions were assessed. Effect of incident adverse drug reactions on the LOS was determined using multiple Cox regression. A secondary analysis was conducted in patients aged ≥ 65 years. Main outcome measure Incident adverse drug reactions (new events occurring in hospital) and their effect on the LOS in older inpatients. Results A total of 229 acutely ill older persons ≥ 60 years were followed-up. Fifty-six of them suffered 77 adverse drug reactions (incident rate 24.5%; 95% CI: 19.0, 30.5), 70.1% type A. Adverse drug reactions were severe in 5.4% of cases. Causality assessment indicated the majority were probable (57.1%) and 3.9% certain. Cardiovascular agents were the therapeutic class more frequently involved. The most frequent adverse drug reaction was hypotension (19.5%). Patients with adverse drug reactions had a significantly prolonged LOS than those without adverse drug reactions (12.4 ± 11.0 versus 7.3 ± 6.4 days; p < 0.0001) (adjusted Hazard Ratio 0.63; 95% CI: 0.46, 0.87; p < 0.01), respectively. The incidence rate of adverse drug reactions in patients ≥ 65 years was 25.1% (95% CI: 19.0; 32.1), and their occurrence was significantly associated with a prolonged LOS (p < 0.05). Conclusion One in four acutely ill older persons hospitalized in the internal medicine service suffered at least one incident adverse drug reaction, which prolonged the LOS by 5 days. There is a potential to optimize the use of hospital beds and medication safety by preventing adverse drug reactions in geriatric patients.
Literatur
1.
Zurück zum Zitat Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255–9.CrossRef Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255–9.CrossRef
2.
Zurück zum Zitat Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–86.PubMedPubMedCentral Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079–86.PubMedPubMedCentral
3.
Zurück zum Zitat White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events. Pharmacoeconomics. 1999;15(5):445–58.CrossRef White TJ, Arakelian A, Rho JP. Counting the costs of drug-related adverse events. Pharmacoeconomics. 1999;15(5):445–58.CrossRef
4.
Zurück zum Zitat Davies EC, Green CF, Mottram DR, et al. Adverse drug reactions in hospitals: a narrative review. Curr Drug Saf. 2007;2(1):79–87.CrossRef Davies EC, Green CF, Mottram DR, et al. Adverse drug reactions in hospitals: a narrative review. Curr Drug Saf. 2007;2(1):79–87.CrossRef
5.
Zurück zum Zitat Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.CrossRef Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.CrossRef
6.
Zurück zum Zitat Wester K, Jönsson AK, Spigset O, et al. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol. 2008;65(4):573–9.CrossRef Wester K, Jönsson AK, Spigset O, et al. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol. 2008;65(4):573–9.CrossRef
7.
Zurück zum Zitat Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS ONE. 2009;4(2):e4439.CrossRef Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS ONE. 2009;4(2):e4439.CrossRef
8.
Zurück zum Zitat Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ. Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: a prospective study. BMC Clin Pharmacol. 2007;7:8.CrossRef Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ. Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: a prospective study. BMC Clin Pharmacol. 2007;7:8.CrossRef
9.
Zurück zum Zitat Tangiisuran B, Gozzoli MP, Davies JG, Rajkumar C. Adverse drug reactions in older people. Rev Clin Gerontol. 2010;20(03):246–59.CrossRef Tangiisuran B, Gozzoli MP, Davies JG, Rajkumar C. Adverse drug reactions in older people. Rev Clin Gerontol. 2010;20(03):246–59.CrossRef
10.
Zurück zum Zitat Sari AB, Sheldon TA, Cracknell A, et al. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review. BMJ. 2007;334(7584):79.CrossRef Sari AB, Sheldon TA, Cracknell A, et al. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review. BMJ. 2007;334(7584):79.CrossRef
11.
Zurück zum Zitat Waller P, Shaw M, Ho D, et al. Hospital admissions for ‘drug-induced’ disorders in England: a study using the Hospital Episodes Statistics (HES) database. Br J Clin Pharmacol. 2005;59(2):213–9.CrossRef Waller P, Shaw M, Ho D, et al. Hospital admissions for ‘drug-induced’ disorders in England: a study using the Hospital Episodes Statistics (HES) database. Br J Clin Pharmacol. 2005;59(2):213–9.CrossRef
12.
Zurück zum Zitat Sera L, McPherson M. Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy. Clin Geriatr Med. 2012;28(2):273–86.CrossRef Sera L, McPherson M. Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy. Clin Geriatr Med. 2012;28(2):273–86.CrossRef
13.
Zurück zum Zitat Tangiisuran B, Davies JG, Wright JE, Rajkumar C. Adverse drug reactions in a population of hospitalized very elderly patients. Drugs Aging. 2012;29(8):669–79.PubMed Tangiisuran B, Davies JG, Wright JE, Rajkumar C. Adverse drug reactions in a population of hospitalized very elderly patients. Drugs Aging. 2012;29(8):669–79.PubMed
14.
Zurück zum Zitat Mangoni A. Geriatric medicine in an aging society: Up for a challenge? Front Med. 2014;1:10.CrossRef Mangoni A. Geriatric medicine in an aging society: Up for a challenge? Front Med. 2014;1:10.CrossRef
17.
Zurück zum Zitat Harugeri A, Parthasarathi G, Ramesh M, Guido S, Basavanagowdappa H. Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals. J Postgrad Med. 2011;57(3):189–95.CrossRef Harugeri A, Parthasarathi G, Ramesh M, Guido S, Basavanagowdappa H. Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals. J Postgrad Med. 2011;57(3):189–95.CrossRef
18.
Zurück zum Zitat Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.CrossRef Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.CrossRef
19.
Zurück zum Zitat Hartwig S, Siegel J, Schneider P. Preventability and severity assessment in reporting adverse drug reactions. Am J Health-Syst Pharm. 1992;49:2229–32.CrossRef Hartwig S, Siegel J, Schneider P. Preventability and severity assessment in reporting adverse drug reactions. Am J Health-Syst Pharm. 1992;49:2229–32.CrossRef
20.
Zurück zum Zitat Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts E, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.CrossRef Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts E, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.CrossRef
21.
Zurück zum Zitat Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Davies DM, editor. Textbook of adverse drug reactions. Oxford: Oxford University Press; 1977. p. 10. Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Davies DM, editor. Textbook of adverse drug reactions. Oxford: Oxford University Press; 1977. p. 10.
22.
Zurück zum Zitat WHO anatomical therapeutic chemical (ATC) classification. Oslo: BMJ Publishing Group; 2019. WHO anatomical therapeutic chemical (ATC) classification. Oslo: BMJ Publishing Group; 2019.
23.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR. New method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–83.CrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. New method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–83.CrossRef
24.
Zurück zum Zitat Pires de Figuereido T, de Souza Groia R, Costa S, Gonzaga do Nascimento M, MoreiraRes A. Factors associated with adverse drug reactions in older inpatients in teaching hospital. Int J Clin Pharm. 2017;39(4):679–85.CrossRef Pires de Figuereido T, de Souza Groia R, Costa S, Gonzaga do Nascimento M, MoreiraRes A. Factors associated with adverse drug reactions in older inpatients in teaching hospital. Int J Clin Pharm. 2017;39(4):679–85.CrossRef
25.
Zurück zum Zitat Lavan A, Eustace J, Dahly D, Flanagan E, Gallagher P, et al. Incident adverse drug reactions in geriatric inpatients: a multicentred observational study. Ther Adv Drug Saf. 2018;9(1):13–23.CrossRef Lavan A, Eustace J, Dahly D, Flanagan E, Gallagher P, et al. Incident adverse drug reactions in geriatric inpatients: a multicentred observational study. Ther Adv Drug Saf. 2018;9(1):13–23.CrossRef
26.
Zurück zum Zitat O’Connor MN, O’Sullivan D, Gallagher PF, et al. Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons’ prescriptions and screening tool to alert to right treatment criteria: a cluster randomized controlled trial. J Am Geriatr Soc. 2016;64(8):1558–66.CrossRef O’Connor MN, O’Sullivan D, Gallagher PF, et al. Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons’ prescriptions and screening tool to alert to right treatment criteria: a cluster randomized controlled trial. J Am Geriatr Soc. 2016;64(8):1558–66.CrossRef
27.
Zurück zum Zitat Gokula M, Holmes HM. Tools to reduce polypharmacy. Clin Geriatr Med. 2012;28(2):323–41.CrossRef Gokula M, Holmes HM. Tools to reduce polypharmacy. Clin Geriatr Med. 2012;28(2):323–41.CrossRef
28.
Zurück zum Zitat Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315(7115):1096–9.CrossRef Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315(7115):1096–9.CrossRef
29.
Zurück zum Zitat Davies E, O’Mahony M. Adverse drug reactions in special populations—the elderly. Br J Clin Pharmacol. 2014;80(4):796–807.CrossRef Davies E, O’Mahony M. Adverse drug reactions in special populations—the elderly. Br J Clin Pharmacol. 2014;80(4):796–807.CrossRef
30.
Zurück zum Zitat Formica D, Sultana J, Cutroneo PM, Lucchesi S, Angelica R, Crisafulli S, et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018;17(7):681–95.CrossRef Formica D, Sultana J, Cutroneo PM, Lucchesi S, Angelica R, Crisafulli S, et al. The economic burden of preventable adverse drug reactions: a systematic review of observational studies. Expert Opin Drug Saf. 2018;17(7):681–95.CrossRef
31.
Zurück zum Zitat Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS ONE. 2014;9(11):e112133.CrossRef Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study. PLoS ONE. 2014;9(11):e112133.CrossRef
32.
Zurück zum Zitat Hoonhout LHF, De Bruijne MC, Wagner C, Asscheman H, Van Der Wal G, Van Tulder MW. Nature, occurrence and consequences of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug Saf. 2010;33(10):853–64.CrossRef Hoonhout LHF, De Bruijne MC, Wagner C, Asscheman H, Van Der Wal G, Van Tulder MW. Nature, occurrence and consequences of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug Saf. 2010;33(10):853–64.CrossRef
33.
Zurück zum Zitat O’Connor MN, Gallagher P, Byrne S, O’Mahony D. Adverse drug reactions in older patients during hospitalization: are they predictable? Age Ageing. 2012;41:771–6.CrossRef O’Connor MN, Gallagher P, Byrne S, O’Mahony D. Adverse drug reactions in older patients during hospitalization: are they predictable? Age Ageing. 2012;41:771–6.CrossRef
Metadaten
Titel
Incident adverse drug reactions and their effect on the length of hospital stay in older inpatients
verfasst von
Tamara Sandoval
Matías Martínez
Fabián Miranda
Marcela Jirón
Publikationsdatum
17.11.2020
Verlag
Springer International Publishing
Erschienen in
International Journal of Clinical Pharmacy / Ausgabe 4/2021
Print ISSN: 2210-7703
Elektronische ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-020-01181-3

Weitere Artikel der Ausgabe 4/2021

International Journal of Clinical Pharmacy 4/2021 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.