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Scheduled adults taking at least four chronic medications and hospitalized over 48 hours underwent reconciliation using hospital and primary care electronic records plus a structured interview, with discrepancies classified by SEFH criteria. Among 43 included patients, 86% of 282 medications had discrepancies, 44% were real, and real discrepancies were often driven by unjustified omissions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/medication-reconciliation-in-the-surgical-setting-a-cross-sectional-study-in-polymedicated-patients/461635/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/medication-reconciliation-in-the-surgical-setting-a-cross-sectional-study-in-polymedicated-patients/461635.png","ImageObject",300,407,{"name":92,"@type":93},"dhado","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study’s primary objective?","Question",{"text":112,"@type":113},"To assess the incidence, nature, and clinical relevance of medication discrepancies during the perioperative period in polymedicated surgical patients, and to examine factors associated with real discrepancies.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were medication reconciliations and discrepancies evaluated?",{"text":117,"@type":113},"Medication reconciliation used hospital and primary care electronic records supplemented by a structured patient interview, and discrepancies were classified as justified or real according to SEFH criteria.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the study find about the frequency and type of discrepancies?",{"text":121,"@type":113},"Among 270 assessed patients, 43 met inclusion criteria; 86% of the 282 analyzed medications showed discrepancies, with 44% being real discrepancies, mainly due to unjustified omission.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461635,1790812027,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},5909893218464,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Article  \nMedication Reconciliation in the Surgical Setting: A Cross-Sectional Study in Polymedicated Patients  \nMercedes Jiménez-Heredia 1, *, Vlada Zabrodotska-Maksymyuk 2, Carmen Carrión-Carrión 3, María Galiana-Sastre 3, Joaquin Ortega Serrano 4 and Diego Cano-Blanquer 3, *  \nAcademic Editors: Patrice Forget, Dimitrios E. Magouliotis and Dimitris Zacharoulis  \nReceived: 11 November 2025  \nRevised: 18 December 2025  \nAccepted: 26 December 2025  \nPublished: 29 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Servicio de Farmacia, Hospital Clínic de Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain  \n2 Centro de Salud Miguel Servet, Departamento de Salud de Valencia-La Fe, Calle Amigos del Corpus S/N, 46025 Valencia, Spain; [zabodotska_vla@gva.es](zabodotska_vla@gva.es)  \n3 Servicio de Farmacia, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibañez 17,  \n46010 Valencia, Spain; [carrion_carcar@gva.es](carrion_carcar@gva.es) (C.C.-C.); [galiana_marsas@gva.es](galiana_marsas@gva.es) (M.G.-S.)  \n4 Departamento de Cirugía, Facultad de Medicina y Odontología, Universidad de Valencia, Avenida Blasco Ibañez 15, 46010 Valencia, Spain; [joaquin.ortega@uv.es](joaquin.ortega@uv.es)  \n* [Correspondence: mejimenez@clinic.cat](Correspondence: mejimenez@clinic.cat) (M.J.-H.); [cano_die@gva.es](cano_die@gva.es) (D.C.-B.)  \nAbstract  \nObjectives: This study aimed to assess the incidence, nature, and clinical relevance of medication discrepancies identified during the perioperative period in polymedicated surgical patients, and to examine factors associated with the occurrence of real discrepancies. Methods: A cross-sectional study was conducted in scheduled surgical patients admitted to the General Surgery department of a tertiary-care hospital. Eligible adults were required to be taking ≥4 chronic medications, have restored oral tolerance, and remain hospitalized for more than 48 h. Medication reconciliation was performed using hospital and primary care electronic records, complemented by a structured patient interview. Discrepancies were classified as justified or real according to SEFH criteria. Statistical analysis included descriptive methods, normality testing, correlation analyses, and generalized linear models. Results: Out of 270 assessed patients, 43 met inclusion criteria. A total of 282 medications were analyzed, with 243 (86%) showing discrepancies. 44% were real discrepancies, primarily due to unjustified omission. The average number of real discrepancies per patient was 5.7 (95% CI: 4.8–6.5) . Cardiovascular (35.2%) and nervous system drugs (23.2%) were most affected. Real discrepancies with potential clinical severity accounted for 36.8%, including cases of asthma exacerbation, withdrawal syndromes, insomnia, and hypertensive crises. In 73% of pre-anesthesia reports, no specific recommendations regarding chronic medication management were provided. Conclusions: Medication reconciliation revealed frequent and clinically relevant discrepancies in this high-risk cohort of polymedicated surgical patients. Larger, more representative studies are needed to confirm these findings and to inform broader perioperative safety strategies.  \nKeywords: medication reconciliation; polymedicated patients; medication discrepancies; perioperative safety; pharmacist intervention  \n1. Introduction  \nAdvancements in surgical and anesthetic techniques have increased the number of elderly patients undergoing surgery [1], often with higher comorbidity, impaired renal/hepatic function, and complex chronic pharmacotherapy [2] . These factors are associated with lower survival and a higher incidence of adverse events [3] .  \nDuring the perioperative period, most chronic treatments can be continued without additional risk; however, certain medications may amplify ane","cbCaiaqAigtXjy41","https://ap.wps.com/l/cbCaiaqAigtXjy41","pdf",713626,"English","# Abstract\n## Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction\n## Perioperative medication risk and medication reconciliation\n## Pharmacist role","[{\"question\":\"What was the study’s primary objective?\",\"answer\":\"To assess the incidence, nature, and clinical relevance of medication discrepancies during the perioperative period in polymedicated surgical patients, and to examine factors associated with real discrepancies.\"},{\"question\":\"How were medication reconciliations and discrepancies evaluated?\",\"answer\":\"Medication reconciliation used hospital and primary care electronic records supplemented by a structured patient interview, and discrepancies were classified as justified or real according to SEFH criteria.\"},{\"question\":\"What did the study find about the frequency and type of discrepancies?\",\"answer\":\"Among 270 assessed patients, 43 met inclusion criteria; 86% of the 282 analyzed medications showed discrepancies, with 44% being real discrepancies, mainly due to unjustified omission.\"}]","Medication Reconciliation in the Surgical Setting - A Cross-Sectional Study in Polymedicated Patients | PDF",1790762025,23]