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

Strategies to amend clinician prescription patterns are of critical importance in addressing opioid abuse and opioid-related deaths across the United States. One potential approach involves targeting opioid-prescription practices in the perioperative period. However, little is known about the outcomes of patients who are prescribed opioids and other high-risk medications such as benzodiazepines in the perioperative period. In this retrospective cohort study, 42,170 non-cardiac surgical cases were studied to evaluate the impact of opioid and benzodiazepine prescriptions filled within 6 months preoperatively on short- and long-term survival. Of these cases, 17.7% had prescriptions for opioids only, 7.4% had prescriptions for benzodiazepines only, and 6.2% had prescriptions for both medications. At baseline, patients who received preoperative prescriptions for either opioids, benzodiazepines, or both had a higher incidence of comorbidities and were more likely to have an intermediate or high frailty score. Researchers found that both 30-day and 1-year mortality rates were greater in those who received preoperative prescriptions for both opioids and benzodiazepines compared with other groups (30-day mortality for opioids and benzodiazepines 3.3%, opioids only 1.2%, benzodiazepines only 1.8%, neither medication 1.4%, p<0.001 between all groups; 1-year mortality for opioids and benzodiazepines 11.1%, opioids only 5.6%, benzodiazepines 8.5%, neither medication 4.8%, p<0.001 between all groups). When compared with propensity-matched controls that received no preoperative medications, however, there was no difference in 30-day or long-term mortality for those with a preoperative prescription for opioids only (30-day: 1.3% vs, 1.0%, p=0.23; long-term: HR 1.12, 95% CI 1.01 to 1.24, p=0.03). Similarly, there was no significant difference in 30-day or long-term mortality when assessing benzodiazepines only (30-day: 1.9% vs 1.5%, p=0.32; long-term: HR 1.11, 95% CI 0.98 to 1.26, p=0.11). Finally, researchers found that those who filled opioid or benzodiazepine prescriptions preoperatively were more likely to consume these medications postoperatively (opioids only 43%, benzodiazepines only 23%, both 66%) compared with patients who filled neither prescription (12%) (p<0.001 for all). In summary, this study suggests that preoperative opioid and benzodiazepine prescription fills within 6 months of surgery may be associated with increased short- and long-term mortality, as well as persistent postoperative opioid consumption. This underlines the importance of developing interventions to limit the potential harm of these medications in perioperative settings.

Click to read the study in JAMA Surgery

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