ATLANTA—The American Geriatrics Society (AGS) Beers Criteria is a list of potentially inappropriate medications that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions.

A study in Clinical Therapeutics pointed out that more than 9,000 total knee arthroplasties are performed each year in VA hospitals, primarily on older adults. Yet, according to Atlanta VAMC-led researchers, little data on the administration of Beers List drugs following arthroplasty currently exists in the literature.1

The study team sought to quantify the risks of these drugs following TKA, hypothesizing that increasing doses of Beers List drugs would be associated with increased risks for readmission, reoperation, emergency department visits and mortality.

Complicated and bilateral procedures were excluded in the retrospective cohort study of TKA procedures performed in VA hospitals from 2010 to 2014. Data  were obtained from the VA Corporate Data Warehouse.

Among the outcomes examined were readmission, postoperative ED visits, reoperation on ipsilateral knee, and mortality. In addition, Beers List drugs were divided into three  categories:

  • medications to use with caution (Beers 0);
  • medications to avoid in older adults (Beers 1); and
  • medications to avoid in certain disease states (Beers 2).

Researchers pointed out that Beers 2 was not included in the final analysis due to an inability to verify appropriate diagnostic criteria without manual chart review. The authors looked at the total number of medication doses in the first 48 hours after surgery compared to the listed outcomes.

Data from 12,639 TKAs were analyzed involving patients with a mean age of 65.06 years. Most, 77.8% of patients, received Beers List drugs while admitted.

Researchers determined that the most frequently administered Beers List drugs were proton pump inhibitors, NSAIDs, insulin, α-blockers, benzodiazepines, antihistamines, muscle relaxants and antipsychotics.

In addition, they identified a dose-dependent increase in readmission and ED visits in the Beers 1 group. The odds ratios were 1.03 for 30-day readmission and 1.02 at 90 days. The odds ratios for ED visits were 1.05 for 72-hour ED visits and 1.04 for ED visits within seven and 30 days.

Noting that the odds ratios were set at 1-unit dose intervals, researchers advised that all results were found after control for VA facility, sex, age, American Society of Anesthesiologists class, Charlson score, case length and body mass index.

“The group of medications to avoid (Beers 1) from the 2015 Beers List showed associations with increased frequency of readmission and postoperative ED visits. Reinforcement of the need to avoid those drugs during surgical care will hopefully reduce such complications,” the authors concluded.

They wrote that limitations of the study included not controlling for overall discharge drug count and reliance on the outpatient problem list for outpatient diagnoses. Additional subgroup analysis will be performed to see whether specific drugs pose a higher than risk others, researchers advised.

  1. Anderson BJ, Liu M, Cui X, Stevens M, Arensman MA. Adverse Outcomes Associated With Inpatient Administration of Beers List Medications Following Total Knee Replacement. Clin Ther. 2020;42(4):592-604.e1. doi:10.1016/j.clinthera.2020.02.017