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Surgery & Supplements: Transparency Is Critical

Surgery & Supplements: Transparency Is Critical
Author Information (click to view)

James M. Moore, MD

Clinical Professor of Anesthesiology & Perioperative Medicine
Administrative Director, Preoperative Evaluation and Planning Center
University of California, Los Angeles
Physician Informaticist
UCLA Health System
President
California Society of Anesthesiologists

James M. Moore, MD, has indicated to Physician’s Weekly that he has no financial disclosures to report.

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James M. Moore, MD (click to view)

James M. Moore, MD

Clinical Professor of Anesthesiology & Perioperative Medicine
Administrative Director, Preoperative Evaluation and Planning Center
University of California, Los Angeles
Physician Informaticist
UCLA Health System
President
California Society of Anesthesiologists

James M. Moore, MD, has indicated to Physician’s Weekly that he has no financial disclosures to report.

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Dietary supplements, including multivitamins, are no longer just taken by “weekend warriors,” but also by mainstream America, including a growing number of women. According to data from the 2012 National Health Interview Survey, nearly 18% of American adults—or more than 40 million people—take dietary supplements. This is beneficial in some cases because many supplements can provide important health benefits and complement a healthy lifestyle, in addition to a good diet and regular exercise.

The problem, however, is that dietary supplements are so closely associated with diet and health that many patients fail to disclose to their medical providers that they are taking them. When patients fail to disclose this information, clinicians may unknowingly provide treatment plans or prescribe medications that could lead to adverse reactions or interactions with dietary supplements.

 

Don’t Ask, Don’t Tell

A recent study published in Patient Education and Counseling suggests this lack of transparency is more pervasive than what has previously been assumed in hospitalized patients. Researchers at Boston Medical Center looked at 558 hospital patients, 60% of whom used dietary supplements. Only 36% of this subset had use of supplements documented at their admission to the hospital. Just 18% told healthcare providers about their dietary supplement use, and only one in five were even asked about dietary supplement use by their healthcare providers.

Ideally, patients should be asked at admission whether they use dietary supplements, disclose the products they use, and then document use of these supplements in medical records. However, only 6% of supplement users met all three criteria, according to research. Investigators also determined that documentation of dietary supplement use on medical charts was lower among older patients and non-white patients.

 

Confusion Persists

It’s not surprising that healthcare consumers may be confused about the safety of supplements. Vitamin E, for example, is known to help with healing of scars, but this is true only for topical vitamin E, not the orally ingested type. This confusion may lead patients to mistakenly neglect to inform their physicians of their use. This can be especially problematic in the case of oral vitamin E. When this vitamin is taken in combination with anticoagulants or dietary supplements that impede coagulation, the result can be exacerbating anticoagulant effects.

Similarly, some patients take herbal supplements, such as St. John’s wort, ginkgo biloba, and feverfew regularly. But the problem is they often consider them to be part of their diet, and therefore do not reveal their use. These supplements can be associated with bleeding and operative complications.

 

Surgical Considerations

Although alarming, these findings are important for both clinicians and patients when considered in the context of surgery. Internet searches can yield numerous listings for supplements related to the full surgical experience—ranging from “supplement recommendations for surgical strategies” to “supplements to help heal from surgery”—but under no circumstances should that be taken as a green light to withhold information from surgical teams. Patients should be empowered to be forthcoming with their physicians, particularly their anesthesiologists, about all medications and supplements, prescribed and over-the-counter, that they are taking prior to surgery. Only then can all the effects and interactions of substances be given their due consideration.

Regarding the finding that documentation of supplement use occurred least among seniors and non-white patients, two simple considerations may be helpful. Physicians should ensure that medical instructions are communicated clearly and simply. We also need to be culturally and linguistically appropriate. Patients should be encouraged to write a list of all medications and supplements and give this list to each provider throughout the care continuum. This may be especially helpful for older adults, considering they may be subject to occasional memory lapses that can be further exacerbated by the stress caused by pending surgery.

The overriding message is that clinicians need to ensure that patients are completely transparent about all medications and supplements they take when preparing for surgery. When we’re fully informed, surgeons, anesthesiologists, and other physicians can provide the safest care to patients.

Readings & Resources (click to view)

Gardiner P, Sadikova E, Filippelli AC, White LF, Jack BW. Medical reconciliation of dietary supplements: don’t ask, don’t tell. Patient Educ Couns. 2015;98:512-517. Available at: http://www.pec-journal.com/article/S0738-3991(15)00002-6/abstract.

Geller AI, Shehab N, Weidle NJ, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373:1531-1540.

Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173:355-361.

Cohen PA. Hazards of hindsight—monitoring the safety of nutritional supplements. N Engl J Med. 2014;370:1277-1280.

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