Surgery does not end when the operation ends: this review shows that across oncology, bariatrics, orthopedics, transplantation, and vascular care, postoperative medication adherence is often the hidden determinant of recurrence, complications, and survival. The full read is worth it because it separates where adherence reliably fails, which barriers drive that failure, and which interventions actually help keep patients on treatment after discharge.
Additional notes
Although this review spans multiple surgical specialties, it is included in the Vascular Health issue because medication adherence after surgery is highly relevant to vascular outcomes, especially in areas such as carotid disease, secondary prevention, and revascularization care.
Abstract: The aim of this review is to evaluate the current landscape of postoperative medication adherence, identifying common barriers to compliance and assessing the effectiveness of various interventions designed to improve adherence rates. The review utilises 262 original studies with 2377896 total participants (topic deduplicated ΣN). This evidence map suggests that medication adherence after surgery is commonly suboptimal and often worsens over time, with some of the clearest long-term signals seen in breast cancer endocrine therapy, where persistence fell from 77% at 1 year to 22% at 5 years in one cohort and remained only 46.6% to 57.1% at 5 years in others. Similar adherence burdens were evident in bariatric supplementation, orthopedic thromboprophylaxis, cardiac secondary prevention, and chronic postoperative regimens, while a few short-course or highly supported settings achieved much better adherence, such as 95.2% mean topical steroid adherence after corneal transplantation and 92% to 94% adherence to apixaban-based postoperative thromboprophylaxis in selected cancer surgery cohorts. Across specialties, the most consistent signals support a role for counseling, nurse-led follow-up, case management, reminders, and regimen simplification, whereas non-adherence was repeatedly linked to forgetfulness, treatment complexity, negative medication beliefs, psychological burden, and financial barriers. The mapped evidence also indicates that adherence is clinically meaningful, as poorer postoperative medication use was associated with adverse outcomes including recurrence, major cardiovascular events, rejection, and mortality in several populations. In practice, postoperative care pathways should treat adherence as an ongoing component of surgical recovery rather than a discharge-only task, and future research should prioritize standardized adherence measurement and longer-term, specialty-specific trials that test sustainable behavioral, digital, and cost-sensitive support strategies.
Final search date and database lock: 2026-03-30 00:50:14 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 616
Downloaded Abstracts/Papers: 616
Included original and non-original Abstracts/Papers (all): 265
Included original Abstracts/Papers (Vote counting by direction of effect): 262
Reference Index (links used in paper): 111
Total participants (topic deduplicated ΣN): 2377896
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Reference Index (111)
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