Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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.

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