Preoperative Sedative-hypnotic Medication Use and Adverse Postoperative Outcomes

Area of Science:

• Anesthesiology
• Pharmacology
• Surgical Outcomes Research

Background:

• Benzodiazepine and Z-drug prescriptions have risen globally.
• The impact of preoperative benzodiazepine and Z-drug use on surgical outcomes remains unclear.
• This study addresses a critical knowledge gap in perioperative medication management.

Purpose of the Study:

• To investigate the association between preoperative benzodiazepine and Z-drug use and adverse surgical outcomes.
• To quantify the risk of postoperative adverse events in patients using these medications.
• To evaluate the impact of combined benzodiazepine/Z-drug and opioid prescriptions on surgical safety.

Main Methods:

• Retrospective cohort study using the Optum Clinformatics Datamart (2010-2015).
• Included adults undergoing common surgical procedures.
• Exposure: benzodiazepine or Z-drug prescription within 90 days pre-surgery. Outcome: ED visit or hospital admission for adverse events/overdose or traumatic injury within 30 days post-surgery.

Main Results:

• 12.1% of 785,346 patients used preoperative benzodiazepines or Z-drugs.
• Preoperative use was associated with increased odds of adverse postoperative events (OR 1.13; 95% CI: 1.08-1.18).
• Coprescription with opioids significantly elevated adverse event odds (OR 1.45; 95% CI: 1.37-1.53).

Conclusions:

• Preoperative benzodiazepine and Z-drug use is prevalent and associated with heightened risks of adverse surgical outcomes.
• Combined use with opioids poses a substantial risk.
• Pre-surgical counseling on appropriate use may enhance patient safety.