Table 2.

Summary of outcomes (n=16)

Author, year	Healthcare Utilization	Patient Outcomes	Medication Changes
Cronin, 2011		Vulnerable Elder Survey score decreased significantly in the postintervention group compared to the preintervention group (0.45 versus 2.28, p<0.01).
Hohn, 2014			Among pharmacists’ recommendations for medication change, 75% were implemented by the physician.
Al-Jazairi, 2017			Pharmacy residents made 260 recommendations and 200 (76.92%) were accepted.
Heltne, 2017		No significant difference between the two groups regarding all other QoL or functional measures.	• Proportion of polypharmacy in the interventiongroup at admission changed from 32.8% to 84.3% at discharge • Proportion of polypharmacy in the control group atadmission changed from 39.7% to 70.6% at discharge • However, 209 withdrawals of pre-existing meds in the intervention group and 82 med withdrawals in control group noted (p<0.0001). • Anticholinergic burden did not show statistically significant difference between the two groups. • Intervention group compared to control group used significantly fewer analgesics (0.0001), anxiolytics (p=0.0001), and hypnotic and sedative drugs (p=0.0015) at discharge.
Vilches-Moraga, 2017	• Mean LOS reduced from 14.6 to 12.5 days for post-intervention group. • No group differences between pre- and post-intervention groups in 30-day readmission rates.	26% developed postoperative delirium, 32.6% acute kidney injury, and 37% constipation.	Significant reduction in meds at discharge (7.6 versus 6.4).
Cortez, 2018	Readmission (1.3% vs 0%) and LOS (6.58±8.0 vs 5.03±3.8) was higher in the pre- versus post-intervention group but not statistically significant.	Higher complication rates (22.5% vs 15.6%), mortality (7.5% vs 6.5%) for postintervention group versus preintervention group, but not statistically significant.
Lin, 2018		Overall survival rate was 9% for 100 days and 78% at 1-year follow up.
Mason, 2018	Mean LOS was reduced by 0.55 bed days.		Medication stopped in 40% of cases and started in 28% of cases.
McDonald, 2018	• Shorter median LOS for intervention versus control group (4 days vs 6 days; P < .001). • Lower readmission rates for the intervention group at 7 days (2.8% vs 9.9%; p=0.001) and 30 days (7.8% vs 18.3%; p=0.001).	Fewer all-type complication rates in the intervention group versus control group (44.8% vs 58.7%; p<0.001) and no statistically significant different in mortality rates; however, higher rates of delirium (28.4% vs 5.6%; p<0.001).
Bansal, 2019	Significant reduction in median LOS in: hepatobiliary (−4.5; IQR: −7,−1; p=0.001), vascular (−2; IQR: −4, 0; p=0.043), and lower GI (−2, IQR: −4, 1.8; p=0.038)	• 48% experienced complications postop (22.2% with postop nausea, 18.2% with infection, 9.1% with cardiac issues,1.5% death, and 6.5% delirium before discharge)	420 interventions by pharmacists and 44.3% related to medication optimization and 55.7% related to perioperative management.
Boersma, 2019		3-month mortality did not differ significantly between groups.	• More medication changes were implemented in the intervention group versus control group (PIMs 46.2% vs 15.3%, P < .005). • Most frequently recommended medications for change were: vitamin D, ACE-I, statins, PPIs, benzodiazepines, analgesics, and antiplatelet drugs.
Gleich, 2019	Mean LOS was not statistically significantly different between groups.		• 85.4% with PIMs in the control group and 22.2% with PIMs in the intervention group (p<0.001). • No adjustments in the control group, but 48.1% of medications adjusted in the intervention group by the geriatrician.
Kimura, 2019			• PIMs defined by STOPP-J were 232 and 61 (26%) were recommended for modification by a physician and 82% were accepted, while 50 (22%) were discontinued by the pharmacist. • PIMs defined by STOPP version 2 were 133 and 61(46%) were recommended for modification by a physician and 89% were accepted, while 54 (41%) were changed by the pharmacists.
Shafiekhani, 2019	Mean LOS for patients with drug-drug interactions was 7.00 ± 4.00 days and those without drug-drug interactions was 5.80 ± 2.20 days (p<0.001)		• 62% of the intervention for medication change was accepted by physicians. • 7.5% drug interactions were prevented due to intervention.
Zulig, 2019			Referral generated to pharmacy in 89% of cases, 26% received services.
Mehta, 2020		Non-naïve users: 2.9% developed C difficile infection Naïve users: 1% developed C difficile infection	Non-naïve users: Overall deprescribing rate was 10% (general surgery was 4% and orthopedic surgery was 7%). Naïve users: Overall deprescribing rate was 26% (general surgery was 50% and orthopedic surgery was 0%).