Association Between Gabapentinoids and Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Critical Care Medicine

Background:

• Gabapentinoids are increasingly used perioperatively.
• Previous studies linked gabapentinoids to increased postoperative pulmonary complications (PPCs) in general surgery.
• The effect of gabapentinoids in thoracic surgery remains unclear.

Purpose of the Study:

• To investigate the association between perioperative gabapentinoid use and PPCs in thoracic surgery.
• To determine if gabapentinoids impact perioperative opioid utilization in this patient population.

Main Methods:

• Retrospective cohort study of 70,336 patients undergoing elective thoracic surgery (2012-2018).
• Propensity score analyses were used to evaluate the association between gabapentinoid administration on the day of surgery and outcomes.
• Primary outcome was a composite of PPCs; secondary outcomes included mechanical ventilation, mortality, length of stay, and opioid consumption.

Main Results:

• Gabapentinoid use on the day of surgery was associated with increased odds of PPCs (OR 1.19).
• Gabapentinoid use was also linked to higher odds of noninvasive (OR 1.30) and invasive (OR 1.14) mechanical ventilation.
• No significant association was found between gabapentinoid use and opioid consumption, hospital mortality, or length of stay.

Conclusions:

• Perioperative gabapentinoid administration in elective thoracic surgery is associated with a higher risk of PPCs.
• Gabapentinoids do not appear to provide an opioid-sparing effect in this setting.
• Findings suggest a need to reconsider the routine use of gabapentinoids in thoracic surgery.