Association Between Preoperative Opioid and Benzodiazepine Prescription Patterns and Mortality After Noncardiac Surgery
Association Between Preoperative Opioid and Benzodiazepine Prescription Patterns and Mortality After Noncardiac Surgery
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DOI：
10.1001/jamasurg.2019.1652
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发表时间：
2019-08-01
期刊：
影响因子：
16.9
通讯作者：
Sigurdsson, Gisli H.
中科院分区：
文献类型：
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作者：
Sigurdsson, Martin, I;Helgadottir, Solveig;Sigurdsson, Gisli H.
重要的是，长期服用阿片类药物和苯二氮卓类药物的患者数量及其长期使用的并发症有所增加。关于术前处方这些药物的患者的围手术期结局的信息有限。目的确定术前6个月内使用阿片类药物和/或苯二氮卓类药物的患者是否会有更高的短期和长期死亡率以及术后阿片类药物消耗量增加。设计、设置和研究对象这项回顾性、单中心、基于人群的队列研究纳入了2005年12月12日至2015年12月31日在冰岛一家国立医院接受非心脏手术的所有18岁或以上患者，随访至2016年5月20日。使用术前6个月内未接受任何药物类别处方的个体生成倾向评分匹配的对照队列。数据分析于2018年4月10日至2019年3月9日进行。暴露患者在术前6个月内仅填写阿片类药物处方、仅填写苯二氮卓类药物处方、阿片类药物和苯二氮卓类药物处方或两种药物均未填写。主要结局和测量指标：与倾向评分匹配的对照组相比的长期生存率。次要结局是30天生存率和持续的术后阿片类药物消耗，定义为术后3个月以上的处方。结果在27787例患者的41170例非心脏手术病例中（16004例女性[57.6%];平均[SD]年龄，56.3 [18.8]岁），术前处方中仅阿片类药物7460例（17.7%），仅苯二氮卓类药物3121例（7.4%），两者均2633例（6.2%）。与未接受任何药物类别的患者相比，接受任何药物类别的术前处方的患者具有更大的合并症负担（Elixhauser合并症指数> 0的患者中，仅接受阿片类药物处方的患者为16%，仅接受苯二氮卓类药物处方的患者为22%，两种药物均为21%，而两种药物均未接受的患者为14%）。30d时无显著性差异（仅阿片类药物：1.3% vs 1.0%; P =.23;仅苯二氮卓类药物：1.9% vs 1.5%; P =.32）或长期（仅阿片类药物：风险比[HR]，1.12 [95% CI，1.01 - 1.24]; P = 0.03;仅苯二氮卓类药物：HR，1.11 [95% CI，0.98 - 1.26]; P = 0.11）仅接受阿片类药物或苯二氮卓类药物治疗的患者与对照组相比的生存率。然而，同时使用阿片类药物和苯二氮卓类药物的患者有更高的30天死亡率（3.2% vs 1.8%; P = 0.004）和更高的长期死亡风险（HR，1.41; 95%CI，1.22 - 1.64; P
ImportanceThe 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. ObjectiveTo 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 ParticipantsThis 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. ExposuresPatients who filled prescriptions for opioids only, benzodiazepines only, both opioids and benzodiazepines, or neither medication within 6 months preoperatively. Main Outcomes and MeasuresLong-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. ResultsAmong 41170 noncardiac surgical cases in 27787 individuals (16004 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