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Abstract & Commentary
Synopsis: Herbal medication use is quite common among surgical patients. This pattern is consistent with the recent substantial increase in the use of alternative medical therapies.
Source: Adusumilli PS, et al. J Am Coll Surg. 2004;198: 583-590.
This study was aimed at identifying the patterns of use of herbal medications in patients undergoing surgery. It was designed as a prospective study using a simple questionnaire in surgical patients 18 years or older, presenting for elective surgery to a New York City hospital over a 10-week period. The survey utilized was developed on the basis of a literature search aimed at determining the types of herbal medicines commonly used in the United States that had been documented to have interactions in the perioperative period in surgical patients.
A total of 3362 eligible participants were approached preoperatively to complete the questionnaire with a response rate of 65%. Fifty-seven percent were women, 73% college educated, 72% non-smokers and 58% belonged to the higher income group. Fifty-seven percent of respondents admitted using herbal medications at some point in their life; 38% had consumed herbal preparations in the 2 years prior to the procedure and 16% continued to use herbal medicine during the month of their surgery.
Herbal medicines were more commonly consumed by those patients undergoing gynecological surgery (52%) and the lowest (10%) in those undergoing vascular surgery procedures. An important observation was the fact that a significantly higher number of patients who used herbal medications did not have a primary care physician (P = 0.005). Those patients that had a good perception of their health status were more likely to take herbal medications than those who had a poor or average self-rating of their health.
Among those patients taking herbal medication, only 7% volunteered their herbal medicine consumption history to their health care providers. A good number of patients (17%) preferred taking herbal medications because of their dissatisfaction with conventional health care. The prevalence of alternative therapies was ascertained in those patients that answered the survey demonstrating chiropractic, acupuncture, hypnosis, homeopathy, and spiritual healing practices among others.
Comment by Joseph Varon, MD, FACP, FCCP, FCCM
Complementary and alternative medicines (CAM) are gaining increased interest among American patients.1 It is not surprising that many illnesses, including those requiring surgery, might lead patients to seek alternative and complimentary medicine therapeutics.
The practice of CAM in its traditional form requires individualized therapy. In the paper by Adusumulli and associates, an attempt to identify the patterns of utilization of herbal medicines as a form of CAM is accomplished. It is surprising to find out that a large number of patients presenting for elective surgery either were currently consuming herbal medications or had done so in the 2 years prior to the surgical procedure.
What is probably more important for the primary care clinician is the fact that most patients did not "volunteer" the information to their health care providers.
Many herbal medications have been shown to interfere with the pharmacokinetics of a variety of medications and anesthetic agents.2 In addition, many herbal medications have been associated to a variety of potentially lethal reactions.3
This paper is also important because it reinforces the concept of self-medication. Many patients in this survey did not have a primary care provider. Clearly, CAM and the use of herbal medications probably have a role in modern medicine. However, clinicians must be astute and inquire about the use of these agents due to their potential toxicity.
1. Eisenberg D, et al. JAMA. 1998;280:1569-1575.
2. Kaye AD, et al. Anesthesiol Clin North Am. 2004;22:125-139.
3. Bent S, Ko R. Am J Med. 2004;116:478-485.
Dr. Varon is Professor at the University of Texas Health Science Center in Houston.