Objective: To evaluate the accomplishment of a peri-operative dopaminergic replacement protocol established in our centre from 2011 to 2014, and analyse the main factors associated with a worse compliance.

Background: Parkinson’s disease (PD) patients have a higher admission rate than general population. Complications related to dopaminergic treatment withdrawal are not uncommon, especially in PD patients hospitalized for surgical procedures. A protocol for dopaminergic replacement with rotigotine transdermal patch was established in collaboration with anaesthesiology department in 2011 in our centre.

Methods: We assessed 169 admissions for surgical procedures of PD patients between 2011 and 2014 and 49 admissions previous to the protocol instauration (2009 -2010). We classified these patients whether rotigotine was administered or not and we analysed clinical parameters, average hospital stay, rest days, prescription of non-recommended drugs (mainly antiemetics and neuroleptics), protocol fulfilment and emergency or scheduled admissions.

Results: Between 2009 and 2010 (pre-protocol) rotigotine was administered in 6,1% of patients compared to 75,9% in 2011 (post-protocol). The protocol accomplishment was of 83.8% in Neurosurgery department, 63% in Traumatology and 51.7% in General surgery. A lower average hospital stay (7 [5-11], 8 [5-13]; p=0.067), less rest days (1 [1-3] vs. 1 [2-4]; p=0.04) and lower prescription of non-recommended drugs (56,4% vs 36,5%; p=0,039) were observed in patients in whom rotigotine protocol was carried out. There was a worse compliance of the protocol (56.3% vs. 74.3%; p=0.007) and a higher prescription of non-recommended drugs (69,6% vs 32,7%; p<0,001) for emergency admissions than for scheduled ones.

Conclusions: The establishment of a peri-operative dopaminergic replacement protocol with rotigotine in Parkinson’s disease patients has allowed a significant increase in its administration, contributing to a lower average hospital stay and prescription of non-recommended drugs. More strategies are needed to increase the protocol accomplishment and to reduce the prescription of non-recommended drugs in emergency admissions and in some surgery departments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/peri-operative-dopaminergic-replacement-protocol-with-rotigotine-in-parkinsons-disease-patients/