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Association Between Preoperative Opioid and Benzodiazepine Prescription Patterns and Mortality After Noncardiac Surgery

Sigurdsson, Martin I ; Helgadottir, Solveig ; Long, Thorir E LU ; Helgason, Dadi LU ; Waldron, Nathan H ; Palsson, Runolfur ; Indridason, Olafur S ; Gudmundsdottir, Ingibjorg J ; Gudbjartsson, Tomas and Sigurdsson, Gisli H (2019) In JAMA Surgery 154(8). p.1-9
Abstract

IMPORTANCE: The number of patients prescribed long-term opioids and benzodiazepines and complications from their long-term use have increased. Information regarding the perioperative outcomes of patients prescribed these medications before surgery is limited.

OBJECTIVE: To determine whether patients prescribed opioids and/or benzodiazepines within 6 months preoperatively would have greater short- and long-term mortality and increased opioid consumption postoperatively.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-center, population-based cohort study included all patients 18 years or older, undergoing noncardiac surgical procedures at a national hospital in Iceland from December 12, 2005, to December 31,... (More)

IMPORTANCE: The number of patients prescribed long-term opioids and benzodiazepines and complications from their long-term use have increased. Information regarding the perioperative outcomes of patients prescribed these medications before surgery is limited.

OBJECTIVE: To determine whether patients prescribed opioids and/or benzodiazepines within 6 months preoperatively would have greater short- and long-term mortality and increased opioid consumption postoperatively.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-center, population-based cohort study included all patients 18 years or older, undergoing noncardiac surgical procedures at a national hospital in Iceland from December 12, 2005, to December 31, 2015, with follow-up through May 20, 2016. A propensity score-matched control cohort was generated using individuals from the group that received prescriptions for neither medication class within 6 months preoperatively. Data analysis was performed from April 10, 2018, to March 9, 2019.

EXPOSURES: Patients who filled prescriptions for opioids only, benzodiazepines only, both opioids and benzodiazepines, or neither medication within 6 months preoperatively.

MAIN OUTCOMES AND MEASURES: Long-term survival compared with propensity score-matched controls. Secondary outcomes were 30-day survival and persistent postoperative opioid consumption, defined as a prescription filled more than 3 months postoperatively.

RESULTS: Among 41 170 noncardiac surgical cases in 27 787 individuals (16 004 women [57.6%]; mean [SD] age, 56.3 [18.8] years), a preoperative prescription for opioids only was filled for 7460 cases (17.7%), benzodiazepines only for 3121 (7.4%), and both for 2633 (6.2%). Patients who filled preoperative prescriptions for either medication class had a greater comorbidity burden compared with patients receiving neither medication class (Elixhauser comorbidity index >0 for 16% of patients filling prescriptions for opioids only, 22% for benzodiazepines only, and 21% for both medications compared with 14% for patients filling neither). There was no difference in 30-day (opioids only: 1.3% vs 1.0%; P = .23; benzodiazepines only: 1.9% vs 1.5%; P = .32) or long-term (opioids only: hazard ratio [HR], 1.12 [95% CI, 1.01-1.24]; P = .03; benzodiazepines only: HR, 1.11 [95% CI, 0.98-1.26]; P = .11) survival among the patients receiving opioids or benzodiazepines only compared with controls. However, patients prescribed both opioids and benzodiazepines had greater 30-day mortality (3.2% vs 1.8%; P = .004) and a greater hazard of long-term mortality (HR, 1.41; 95% CI, 1.22-1.64; P < .001). The rate of persistent postoperative opioid consumption was higher for patients filling prescriptions for opioids only (43%), benzodiazepines only (23%), or both (66%) compared with patients filling neither (12%) (P < .001 for all).

CONCLUSIONS AND RELEVANCE: The findings suggest that opioid and benzodiazepine prescription fills in the 6 months before surgery are associated with increased short-and long-term mortality and an increased rate of persistent postoperative opioid consumption. These patients should be considered for early referral to preoperative clinic and medication optimization to improve surgical outcomes.

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; ; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Analgesics, Opioid/therapeutic use, Benzodiazepines/therapeutic use, Drug Prescriptions/statistics & numerical data, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pain, Postoperative/drug therapy, Practice Patterns, Physicians', Preoperative Care/methods, Prognosis, Retrospective Studies, Surgical Procedures, Operative
in
JAMA Surgery
volume
154
issue
8
article number
e191652
pages
1 - 9
publisher
American Medical Association
external identifiers
  • pmid:31215988
  • scopus:85067626104
ISSN
2168-6254
DOI
10.1001/jamasurg.2019.1652
language
English
LU publication?
no
id
a6d81dd1-433c-4e8e-ac34-72a65a491d78
date added to LUP
2024-12-05 16:11:29
date last changed
2024-12-20 05:30:58
@article{a6d81dd1-433c-4e8e-ac34-72a65a491d78,
  abstract     = {{<p>IMPORTANCE: The number of patients prescribed long-term opioids and benzodiazepines and complications from their long-term use have increased. Information regarding the perioperative outcomes of patients prescribed these medications before surgery is limited.</p><p>OBJECTIVE: To determine whether patients prescribed opioids and/or benzodiazepines within 6 months preoperatively would have greater short- and long-term mortality and increased opioid consumption postoperatively.</p><p>DESIGN, SETTING, AND PARTICIPANTS: This retrospective, single-center, population-based cohort study included all patients 18 years or older, undergoing noncardiac surgical procedures at a national hospital in Iceland from December 12, 2005, to December 31, 2015, with follow-up through May 20, 2016. A propensity score-matched control cohort was generated using individuals from the group that received prescriptions for neither medication class within 6 months preoperatively. Data analysis was performed from April 10, 2018, to March 9, 2019.</p><p>EXPOSURES: Patients who filled prescriptions for opioids only, benzodiazepines only, both opioids and benzodiazepines, or neither medication within 6 months preoperatively.</p><p>MAIN OUTCOMES AND MEASURES: Long-term survival compared with propensity score-matched controls. Secondary outcomes were 30-day survival and persistent postoperative opioid consumption, defined as a prescription filled more than 3 months postoperatively.</p><p>RESULTS: Among 41 170 noncardiac surgical cases in 27 787 individuals (16 004 women [57.6%]; mean [SD] age, 56.3 [18.8] years), a preoperative prescription for opioids only was filled for 7460 cases (17.7%), benzodiazepines only for 3121 (7.4%), and both for 2633 (6.2%). Patients who filled preoperative prescriptions for either medication class had a greater comorbidity burden compared with patients receiving neither medication class (Elixhauser comorbidity index &gt;0 for 16% of patients filling prescriptions for opioids only, 22% for benzodiazepines only, and 21% for both medications compared with 14% for patients filling neither). There was no difference in 30-day (opioids only: 1.3% vs 1.0%; P = .23; benzodiazepines only: 1.9% vs 1.5%; P = .32) or long-term (opioids only: hazard ratio [HR], 1.12 [95% CI, 1.01-1.24]; P = .03; benzodiazepines only: HR, 1.11 [95% CI, 0.98-1.26]; P = .11) survival among the patients receiving opioids or benzodiazepines only compared with controls. However, patients prescribed both opioids and benzodiazepines had greater 30-day mortality (3.2% vs 1.8%; P = .004) and a greater hazard of long-term mortality (HR, 1.41; 95% CI, 1.22-1.64; P &lt; .001). The rate of persistent postoperative opioid consumption was higher for patients filling prescriptions for opioids only (43%), benzodiazepines only (23%), or both (66%) compared with patients filling neither (12%) (P &lt; .001 for all).</p><p>CONCLUSIONS AND RELEVANCE: The findings suggest that opioid and benzodiazepine prescription fills in the 6 months before surgery are associated with increased short-and long-term mortality and an increased rate of persistent postoperative opioid consumption. These patients should be considered for early referral to preoperative clinic and medication optimization to improve surgical outcomes.</p>}},
  author       = {{Sigurdsson, Martin I and Helgadottir, Solveig and Long, Thorir E and Helgason, Dadi and Waldron, Nathan H and Palsson, Runolfur and Indridason, Olafur S and Gudmundsdottir, Ingibjorg J and Gudbjartsson, Tomas and Sigurdsson, Gisli H}},
  issn         = {{2168-6254}},
  keywords     = {{Analgesics, Opioid/therapeutic use; Benzodiazepines/therapeutic use; Drug Prescriptions/statistics & numerical data; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain, Postoperative/drug therapy; Practice Patterns, Physicians'; Preoperative Care/methods; Prognosis; Retrospective Studies; Surgical Procedures, Operative}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  pages        = {{1--9}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA Surgery}},
  title        = {{Association Between Preoperative Opioid and Benzodiazepine Prescription Patterns and Mortality After Noncardiac Surgery}},
  url          = {{http://dx.doi.org/10.1001/jamasurg.2019.1652}},
  doi          = {{10.1001/jamasurg.2019.1652}},
  volume       = {{154}},
  year         = {{2019}},
}