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.
• Format: Text
• Language: English
• Published: American Medical Association 2019
• Subjects: Original Investigation; Iceland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584895/; http://www.ncbi.nlm.nih.gov/pubmed/31215988; https://doi.org/10.1001/jamasurg.2019.1652

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 ...