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

• Published in: JAMA Surgery
• Main Authors: Sigurdsson, Martin I, Helgadottir, Solveig, Long, Thorir E, Helgason, Dadi, Waldron, Nathan H, Palsson, Runolfur, Indridason, Olafur S, Gudmundsdottir, Ingibjorg J, Gudbjartsson, Tomas, Sigurdsson, Gisli H
• Other Authors: 1 Division of Anesthesia and Intensive Care Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Division of Anesthesia and Intensive Care Medicine, Akademiska University Hospital, Uppsala, Sweden. 4 Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 5 Department of Anesthesiology, Duke University Hospital, Durham, North Carolina. 6 Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 7 Division of Cardiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. 8 Division of Cardiothoracic Surgery, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
• Format: Article in Journal/Newspaper
• Language: English
• Published: American Medical Association 2019
• Subjects: Ópíóðar; Verkjalyf; Skurðlækningar; Dánarmein; Analgesics; Opioid; benzodiazepines; Prescriptions; Surgical Procedures; Operative; Mortality; Iceland
• Online Access: http://hdl.handle.net/2336/621087; https://doi.org/10.1001/jamasurg.2019.1652

To access publisher's full text version of this article click on the hyperlink below 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 ...