{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:08:59Z","timestamp":1787242139217,"version":"build-2736575974"},"reference-count":74,"publisher":"SAGE Publications","issue":"1-2","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Perioperative Practice"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Polypharmacy is becoming more prevalent due to an ageing population. As more patients are undergoing surgical procedures, it is important to determine which group of patients are at higher risk of poorer outcomes. This review aimed to provide a summary of existing literature and to determine if polypharmacy is associated with poorer perioperative outcomes and to identify any gaps in the literature. This systematic review was conducted using electronic databases PubMed, Embase and Web of Science from their inception to December 2024. Statistical analysis was performed using generic inverse variance method. We identified 45 eligible studies from different countries and different surgical populations. Thirty-two studies (71.11%) defined polypharmacy as the use of five or more medications. Polypharmacy is significantly associated with postoperative delirium (odds ratio\u2009=\u20091.62, 95% confidence interval\u2009=\u20091.32\u20131.98,\n                    <jats:italic toggle=\"yes\">I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%). Although polypharmacy is found to be significantly associated with postoperative delirium, the relationship between polypharmacy and postoperative delirium remains complex.\n                  <\/jats:p>","DOI":"10.1177\/17504589251320818","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T01:14:06Z","timestamp":1740618846000},"page":"29-41","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Association of polypharmacy and perioperative outcomes: Systematic review and meta-analysis"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4271-8955","authenticated-orcid":false,"given":"Yixuan","family":"Lee","sequence":"first","affiliation":[{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Liew","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mui Hian","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu Ling Jacqueline","family":"Sim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-020-02415-y"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2003.017236"},{"issue":"10","key":"e_1_3_3_4_1","article-title":"Hip fracture post-operative mortality and polypharmacy: A new risk predictor?","volume":"15","author":"Al-Khatib Y","year":"2023","unstructured":"Al-Khatib Y, Dasari K 2023 Hip fracture post-operative mortality and polypharmacy: A new risk predictor? Cureus 15 (10) e47089","journal-title":"Cureus"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.04.009"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15174"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-022-01746-x"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2022.05.004"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23369"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2020.03.013"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.011"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2022.04.137"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahjo.2022.100233"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S390906"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2021.679933"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.SLA.0000081085.98792.3d"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2017.11.087"},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2017.07.008"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232857"},{"key":"e_1_3_3_20_1","unstructured":"Ghossein N Kang M Lakhkar AD 2024 Anticholinergic Medications [online] Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK555893\/ [Accessed November 2024]"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/00015458.2017.1337339"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.04.041"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-016-0486-7"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2014.08.012"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09099-9"},{"key":"e_1_3_3_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/wvn.12536"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12072598"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.12.012"},{"key":"e_1_3_3_30_1","first-page":"134","article-title":"Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment","volume":"16","author":"Jeong YM","year":"2016","unstructured":"Jeong YM, Lee E, Kim KI, et al 2016 Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment Biomed Central Geriatrics 16 134","journal-title":"Biomed Central Geriatrics"},{"issue":"3","key":"e_1_3_3_31_1","article-title":"Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study","volume":"7","author":"J\u00f3nsd\u00f3ttir F","year":"2023","unstructured":"J\u00f3nsd\u00f3ttir F, Bl\u00f6ndal AB, Gu\u00f0mundsson A, et al 2023 Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study British Journal of Surgery Open 7 (3) zrad041","journal-title":"British Journal of Surgery Open"},{"issue":"1","key":"e_1_3_3_32_1","first-page":"298","article-title":"Preoperative medication use and postoperative delirium: a systematic review","volume":"17","author":"Kassie GM","year":"2017","unstructured":"Kassie GM, Nguyen TA, Kalisch Ellett LM, et al 2017 Preoperative medication use and postoperative delirium: a systematic review Biomed Central Geriatric 17 (1) 298","journal-title":"Biomed Central Geriatric"},{"key":"e_1_3_3_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.15026"},{"key":"e_1_3_3_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2015.03.004"},{"key":"e_1_3_3_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.01.004"},{"key":"e_1_3_3_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2024.105465"},{"issue":"57","key":"e_1_3_3_37_1","first-page":"12","article-title":"Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery?","volume":"2010","author":"Kristjansson SR","year":"2010","unstructured":"Kristjansson SR, Jordh\u00f8y MS, Nesbakken A, et al 2010 Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? Journal of Geriatric Oncology 2010 (57-65) 12","journal-title":"Journal of Geriatric Oncology"},{"key":"e_1_3_3_38_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.743138"},{"key":"e_1_3_3_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2022.10.022"},{"key":"e_1_3_3_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.11.005"},{"key":"e_1_3_3_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znac014"},{"key":"e_1_3_3_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0110339"},{"key":"e_1_3_3_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050312116671725"},{"key":"e_1_3_3_44_1","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2013.827660"},{"key":"e_1_3_3_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-017-0441-7"},{"key":"e_1_3_3_46_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-017-0621-2"},{"key":"e_1_3_3_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.12.044"},{"key":"e_1_3_3_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2008.02.016"},{"key":"e_1_3_3_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002124"},{"key":"e_1_3_3_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.07.020"},{"key":"e_1_3_3_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2019.109632"},{"key":"e_1_3_3_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-015-0459-z"},{"key":"e_1_3_3_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01626-4"},{"key":"e_1_3_3_54_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002389"},{"key":"e_1_3_3_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24077"},{"key":"e_1_3_3_56_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja13.00200"},{"key":"e_1_3_3_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2020.01.029"},{"key":"e_1_3_3_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2019.01.020"},{"key":"e_1_3_3_59_1","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.27.748"},{"key":"e_1_3_3_60_1","unstructured":"Smith G D\u2019Cruz JR Rondeau B et al 2024 General Anesthesia for Surgeons [online] Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK493199\/ [Accessed November 2024]"},{"key":"e_1_3_3_61_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13133110"},{"key":"e_1_3_3_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2022.10.049"},{"key":"e_1_3_3_63_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40545-020-00230-6"},{"key":"e_1_3_3_64_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.067231"},{"key":"e_1_3_3_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-022-00664-y"},{"key":"e_1_3_3_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.05.041"},{"key":"e_1_3_3_67_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10122550"},{"key":"e_1_3_3_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2022.01.032"},{"key":"e_1_3_3_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.12.042"},{"key":"e_1_3_3_70_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40780-024-00369-3"},{"key":"e_1_3_3_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60806-6"},{"key":"e_1_3_3_72_1","unstructured":"Wells GA Shea B O\u2019Connell D et al 2014 The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [online] Available from: https:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp [Accessed November 2024]"},{"key":"e_1_3_3_73_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S155409"},{"key":"e_1_3_3_74_1","article-title":"Patterns and outcomes of polypharmacy and effect of potentially inappropriate medications in elderly patients undergoing orthopaedic surgeries: A retrospective observational study","volume":"18","author":"Yohannan S","year":"2024","unstructured":"Yohannan S, Johny S, Vergis SK, et al 2024 Patterns and outcomes of polypharmacy and effect of potentially inappropriate medications in elderly patients undergoing orthopaedic surgeries: A retrospective observational study Journal of Clinical and Diagnostic Research 18 FC14-FC17","journal-title":"Journal of Clinical and Diagnostic Research"},{"key":"e_1_3_3_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06650-z"}],"container-title":["Journal of Perioperative Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589251320818","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17504589251320818","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17504589251320818","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:07:05Z","timestamp":1777709225000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17504589251320818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":74,"journal-issue":{"issue":"1-2","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1177\/17504589251320818"],"URL":"https:\/\/doi.org\/10.1177\/17504589251320818","relation":{},"ISSN":["1750-4589","2515-7949"],"issn-type":[{"value":"1750-4589","type":"print"},{"value":"2515-7949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]}}}