Opioids+benzodiazepines months before surgery linked to poorer outcomes

  • Sigurdsson MI & al.
  • JAMA Surg
  • 19 Jun 2019

  • International Clinical Digest
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Takeaway

  • Surgical patients who took both opioids and benzodiazepines within 6 months before noncardiac surgery had higher rates of short- and long-term mortality and persistent postoperative opioid consumption.

Why this matters

  • Patients with a preoperative history of opioid and benzodiazepine use should be referred for medication optimization before surgery to improve outcomes.

Study design

  • Study of 27,787 patients (age, ≥18 years) who underwent noncardiac surgery at a national hospital in Iceland during 2005-2015.
  • Funding: Landspitali University Hospital Research Fund.

Key results

  • 42,170 surgical procedures were performed. 
  • 17.7% of patients received opioids, 7.4% received benzodiazepines, and 6.2% received both opioids and benzodiazepines within 6 months of the procedure.
  • Patients who received both opioids and benzodiazepines vs those who received no medication had significantly higher:
    • 30-day mortality (3.2% vs 1.8%; P=.004) and
    • long-term mortality (aHR, 1.41; P<.001>
  • Compared with patients prescribed neither medication, a higher number of patients had persistent (>3 months) postoperative consumption in the:
    • opioid-only group (43% vs 12%; P <.001>
    • benzodiazepines-only group (23% vs 12%; P<.001 and>
    • both opioid and benzodiazepines groups (66% vs 12%; P<.001>

Limitations

  • Retrospective, single-center study.

Coauthored with Antara Ghosh, PhD