Perioperative Medication Withholding in Patients with Parkinson's Disease: A Retrospective Electronic Health Records Review

Background: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson's disease, has a short half-life of one to two hours. When patients with Parkinson's disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson's disease symptoms. Clear guidelines regarding perioperative symptom management are lacking. Objectives: The goals of this study were threefold: to measure the perioperative duration of the with-holding of carbidopa-levodopa in patients with Parkinson's disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson's disease symptoms. Methods: We conducted a retrospective review of patient electronic health records at a Midwestern public medical center. After applying inclusion and exclusion criteria and evaluating the eligible records, we had a final sample of 89 separate surgical events for 67 discrete patients who had been diagnosed with Parkinson's disease, had undergone any type of surgery excepting Parkinson's disease surgeries, and were taking carbidopa-levodopa. Results: The median duration of carbidopa-levodopa withholding was 12.35 hours, with most surgical procedures (86%) starting at 9 am or later. The most commonly reported exacerbation of Parkinson's disease symptoms was agitation or confusion. Conclusions: For best symptom management, careful consideration should be given to scheduling surgery at the earliest possible time, administering medications as close to the patient's usual dosing schedule as possible, and providing nursing education about optimal medication management for this patient population.