How can I optimize a patient's medication regimen in the perioperative period to reduce surgical complications?

To optimize a patient's medication regimen in the perioperative period and reduce the risk of surgical complications, a comprehensive, multidisciplinary approach is essential. Preoperatively, assess and manage existing medications carefully, including anticoagulants and iron supplementation for anaemia, to minimize bleeding and improve oxygen delivery. For patients with iron-deficiency anaemia, follow NICE recommendations on intravenous or oral iron supplementation, considering alternate-day dosing if side effects occur, to optimize haemoglobin before surgery ¹. Anticoagulation management requires careful risk stratification; bridging therapy decisions should be individualized, although evidence comparing low molecular weight heparin and unfractionated heparin is limited ¹. Venous thromboembolism (VTE) risk must be assessed and mitigated according to NICE VTE guidelines, including perioperative pharmacological prophylaxis where appropriate ¹.

Medication adjustments should also consider comorbidities such as diabetes; tight glucose control with glucose-lowering drugs is not recommended for type 2 diabetes or non-diabetic patients perioperatively, but type 1 diabetes management should follow specific NICE guidance ¹. Analgesic regimens should use a multimodal approach combining paracetamol, NSAIDs (oral preferred), and opioids only when necessary, tailored to patient factors and surgical pain expectations to reduce opioid-related complications ¹. Pre-emptive analgesia and adjuncts like intravenous ketamine may be considered for moderate to severe pain or opioid sensitivity ¹.

Intraoperative medication management includes maintaining fluid balance with intravenous crystalloids and considering cardiac output monitoring for high-risk surgeries to guide fluid therapy and avoid complications ¹. Preoperative lifestyle modifications such as smoking cessation and alcohol reduction also contribute to reducing complications ¹. Recent literature emphasizes the importance of optimizing vascular patients’ medications to reduce respiratory and cardiovascular complications, highlighting the need for individualized medication review and adjustment to improve surgical outcomes (Zhan et al., 2015; Ruscic et al., 2017).

Overall, medication optimization in the perioperative period involves preoperative risk stratification, tailored management of anaemia and anticoagulation, careful analgesic planning, and intraoperative monitoring, all integrated within enhanced recovery programmes to reduce surgical complications effectively ¹ (Zhan et al., 2015; Ruscic et al., 2017).