Medication Adherence After Surgery: Systematic Review with ☸️SAIMSARA.

DOI: 10.62487/saimsara08385f4

Author: saimsara.com

• Generated: 2025-11-26 20:39:01 CET
• Plan: Premium (expanded craft tokens; source: Europe PMC)
• Source: Europe PMC
• Scope: Titles/Abstracts (tiab)
• Keyword Gate: Fuzzy (≥60% of required terms, minimum 2 terms matched in title/abstract)
• Total Abstracts/Papers: 1440
• Downloaded Abstracts/Papers: 1440
• Included original Abstracts/Papers: 533
• Total study participants (naïve ΣN): 1135797

• Bias: Qualitatively inferred from study design fields. Cross-sectional studies are prone to selection and recall bias. Retrospective cohort studies may suffer from confounding and data availability bias. Randomized controlled trials (RCTs) generally offer higher certainty, but many identified here are protocols or pilot studies. Mixed-methods studies offer qualitative insights but may lack generalizability. Case series and single-patient reports provide limited generalizability.

• Determinants of Adherence: Patient factors such as increased age (AOR = 2.751) [3, 59], lower educational level (AOR = 2.406) [3], lower income (AOR = 3.031) [3], and higher number of medications (AOR = 2.925) [3] were associated with poorer adherence. At-risk drinking (r = -0.326) [1] and chronic pain [185] also negatively impacted adherence, while rational medication self-efficacy (r = 0.536) [11] and positive attitudes [25] were positively correlated.
• Clinical Impact of Adherence: Poor adherence to heart failure therapy before CABG was an independent predictor of major adverse cardiovascular events (p < 0.001) [12, 76]. Denosumab discontinuation significantly increased the risk of subsequent vertebral fractures (HR = 1.81) and rib fractures (HR = 2.04) [7]. Good adherence was crucial for improving postoperative outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients [8] and for reducing granulomatous mastitis recurrence (RR = 0.428) [121, 134].
• Strategies for Improving Adherence: Interventions like a blended learning approach in cardiac rehabilitation [9], feedback health education [10], specialized nursing outpatient case management [23], and protocol-driven care [33] demonstrated benefits in improving medication adherence. Digital health tools and mHealth applications also showed promise in increasing adherence [231, 235, 296].
• Preoperative Medication Management: A substantial proportion of patients (41.7%) were non-adherent to preoperative medication advice [2], often due to unclear communication or lack of understanding. Preoperative medication discontinuation was identified as a risk factor for non-adherence, particularly for older patients (AOR = 2.27) and those discontinuing multiple medications (AOR = 1.67) [59]. Pharmacist-led medication reconciliation programs were effective in identifying drug-related problems and improving compliance [64, 220, 256, 381].
• Adherence Challenges in Specific Surgical Contexts: Kidney transplant recipients showed a non-adherence rate of 57.6% to immunosuppressive medication at 12 months [89]. After bariatric surgery, a significant proportion of patients discontinued lifelong vitamin and mineral supplementation (15% for calcium-vitamin D, 12% for vitamin B12) [99]. Adherence to adjuvant endocrine therapy for breast cancer declined over time, from 85.18% at 1 year to 73.68% at 5 years [141].
• Barriers to Adherence: Patients faced barriers related to capability, opportunity, and motivation domains affecting oral anticoagulant adherence after spinal surgery [17]. These included difficulty obtaining medications, transportation challenges, communication issues with the care team, and limited understanding of the care plan, all of which decreased the likelihood of functional improvement (ORs 0.32-0.58) [28]. New adverse drug reactions were also a common barrier to adherence for antiplatelet and statin therapies after major vascular intervention [104].

• Targeted Interventions for Vulnerable Populations: Patients with lower socioeconomic status (lower education, income) [3], elderly individuals [3, 59], and those with alcohol use [1] or psychological comorbidities [98, 339, 348] are at higher risk for poor adherence and require tailored support.
• Enhanced Patient Education and Communication: Unclear communication and lack of understanding are significant barriers to adherence [2, 28]. Comprehensive discharge instructions and ongoing education are crucial, especially for complex regimens or high-risk medications (e.g., anticoagulants [17], immunosuppressants [89]).
• Multimodal Pain Management and Opioid Stewardship: High rates of opioid overprescription and leftover medication are common [370]. Implementing non-opioid protocols [106, 205], multimodal analgesia [49, 179, 341], and digital tapering interventions [38] can reduce opioid use without compromising pain control.
• Importance of Perioperative Medication Reconciliation: Incorrect medication reconciliations are frequent [209, 256, 64], leading to preventable readmissions [26] and complications [183]. Pharmacist-led reconciliation programs significantly improve compliance with perioperative management [381, 220].
• Monitoring and Support for Long-Term Therapies: Adherence to chronic therapies like immunosuppressants [89, 380], anti-osteoporosis medications [117, 217, 230], and adjuvant cancer treatments [141, 207, 411] often declines over time, necessitating sustained monitoring and support programs.

• Standardized Adherence Measurement: Future studies should employ consistent, validated metrics and timepoints for medication adherence across diverse surgical populations to allow for more robust comparisons and meta-analyses [248].
• Longitudinal Studies on Adherence Trajectories: Prospective cohort studies with extended follow-up are needed to understand the long-term patterns and determinants of adherence, especially for chronic post-surgical medications [4, 141].
• Effectiveness of Digital and Telehealth Interventions: More rigorous randomized controlled trials are needed to evaluate the efficacy and cost-effectiveness of digital platforms, remote monitoring, and telehealth coaching on medication adherence across various surgical contexts [38, 155, 204].
• Interventional Studies on Health Literacy: Research should explore the impact of interventions specifically designed to improve patient health literacy, clarify communication, and foster shared decision-making on medication adherence and clinical outcomes [2, 28].
• Impact of Prehabilitation on Adherence: Investigate whether prehabilitation programs (e.g., diet, exercise, psychological preparation) not only improve surgical outcomes but also enhance patients' self-efficacy and adherence to postoperative medication regimens [179, 47].

• Heterogeneous Study Designs — The included studies employed a wide array of designs, from cross-sectional surveys to randomized controlled trials, limiting the ability to draw definitive causal inferences and synthesize quantitative data uniformly.
• Varied Adherence Definitions — Medication adherence was measured using diverse tools (e.g., MARS-5, pill counts, pharmacy refill data) and reported at inconsistent timepoints, precluding a precise meta-analytic pooling of adherence rates.
• Self-Report Bias — A substantial number of studies relied on patient self-report for adherence, which can be subject to recall bias and social desirability bias, potentially overestimating true adherence rates [24, 248].
• Limited Generalizability — Many studies focused on specific surgical populations (e.g., CABG, bariatric, transplant) or medication types, making it challenging to generalize findings across the entire spectrum of surgical patients and postoperative care.
• Lack of Causal Inference — While associations between adherence and outcomes were frequently reported, the cross-sectional nature of many studies prevents establishing causality, meaning it is difficult to definitively state that poor adherence causes adverse outcomes in all contexts.

• Standardized Adherence Metrics — Develop and validate universal metrics for medication adherence in surgical populations, enabling more comparable and robust research.
• Longitudinal Outcome Studies — Conduct prospective, long-term studies to track adherence trajectories and their direct impact on patient-centered clinical outcomes.
• Digital Health Interventions — Design and test digital health tools (e.g., apps, wearables) for personalized medication reminders and education to improve adherence.
• Multidisciplinary Care Models — Evaluate the effectiveness of integrated care teams, including pharmacists and nurses, in enhancing medication management and adherence post-surgery.
• Preoperative Education Programs — Implement and assess comprehensive preoperative education programs to improve patient understanding and readiness for postoperative medication regimens.