Intended for healthcare professionals


Risks of interrupting drug treatment before surgery

BMJ 2000; 321 doi: (Published 23 September 2000) Cite this as: BMJ 2000;321:719

The consequences may be as serious as those from drug errors

  1. David W Noble, consultant in anaesthesia and intensive care medicine (,
  2. Henrik Kehlet, professor of surgery (
  1. Department of Anaesthesia, Intensive Care and Hyperbaric Medicine, Grampian University Hospitals, Aberdeen AB25 2ZN
  2. Department of Surgical Gastroenterology, 435 Hvidovre University Hospital, DK-2650 Hvidovre, Denmark

    Millions of patients worldwide have surgery each year. As well as using a variety of recreational drugs, such as caffeine, tobacco, and alcohol, many of these patients are prescribed therapeutic drugs for concurrent diseases. These drugs are taken for their positive therapeutic benefits, and abrupt interruptions lead at best to a loss of effect and at worst to rebound exacerbations of diseases.1

    Unfortunately, surgery, and major abdominal surgery in particular, can cause patients to abstain from their usual drug treatment. After major abdominal surgery gastric emptying is delayed, making administration of drugs by the oral or nasogastric routes unreliable.2-4 Surgical patients may be particularly vulnerable to complications caused by abstention from drug treatment because of the adaptive and maladaptive physiological and psychological stresses related to surgical trauma that may increase the risk of organ dysfunction. 5 6 However, there is little systematic evidence that quantifies the risks of the abrupt withdrawal of therapeutic drugs in the postoperative setting.

    An observational study by Kennedy and colleagues of over 1000 admissions for general surgery and vascular surgery has made an important preliminary contribution …

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