Document resource
Background and Importance Proper management of chronic medication in surgical patients is essential to ensure their safety during hospitalisation.Pharmaceutical intervention, integrated into the multidisciplinary team, is key to medication reconciliation upon admission. Additionally, postoperative pharmacotherapeutic follow-up performed by the pharmacist is essential to assess and adjust the usual chronic treatment according to the patient‘s new clinical situation, especially in those with comorbidities such as hypertension or diabetes mellitus.Aim and Objectives To evaluate the impact of pharmaceutical intervention on optimising the perioperative management of home medication in surgical patients during hospitalisation.Material and Methods A prospective, longitudinal study was conducted in a tertiary hospital, including all patients reconciled from January 2024 to August 2025.After preoperative management of the patient‘s pharmacotherapeutic history, the pharmacist carried out daily clinical follow-up to optimise home treatment by adjusting the dosage, after reviewing the blood pressure and blood glucose values in hypertensive and/or diabetic patients.Demographic (age, sex, length of stay, clinical service), clinical (number of chronic medications, pharmacotherapeutic objectives), and safety variables (adequacy of treatment and clinical impact of the pharmaceutical intervention) were collected.Results A total of 363 patients were reconciled, whose mean age of 71±14 years, with women predominating 59.2% (215). Most patients belonged to the Orthopaedic Surgery and Traumatology clinical service 89.8% (326), followed by Neurosurgery 8.3% (30) and Urology 1.9% (7). The average hospital stay was 7±7 days.Patients were taking a mean of 7±4 chronic medication. Depending on comorbidities, follow-up was performed to optimise home medication.75.5% (274) of patients required pharmacotherapeutic follow-up: 39.4% (143) focused on blood pressure control, 6.1% (22) on glycaemic monitoring and 30% (109) on both parameters. The remaining 24.5% (89) did not require follow-up regarding home medication management.Of the patients we followed up for proper perioperative pharmacotherapeutic optimisation, 31.3% (86) underwent a dosage adjustment of antihypertensive medication or insulin based on clinical findings. This adjustment allowed for the correction of parameters in 58.1% (50). In the remaining patients, due to clinical instability despite the adjustment of their home treatment, consultation with the Internal Medicine Continuity of Care Unit was requested.Conclusion and Relevance Pharmaceutical intervention, integrated within the multidisciplinary team, ensures proper reconciliation and optimisation of perioperative management of chronic medication in surgical patients during hospitalisation.Conflict of Interest No conflict of interest