Perioperative gabapentin upped the danger of delirium, new antipsychotic use, and pneumonia in older adults after main surgical procedure, a retrospective research confirmed.
Risk of delirium — the first end result of the research — was 3.4% for older sufferers who obtained gabapentin inside 2 days after main surgical procedure and a couple of.6% for individuals who didn’t, with a relative danger (RR) of 1.28 (95% CI 1.23-1.34), reported Dae Hyun Kim, MD, ScD, of Brigham & Women’s Hospital and Hebrew SeniorLife in Boston, and colleagues.
Risk of recent antipsychotic use was 0.8% versus 0.7%, respectively (RR 1.17, 95% CI 1.07-1.29), and danger of pneumonia was 1.3% versus 1.2% (RR 1.11 95% CI 1.03-1.20), the researchers reported in JAMA Internal Medicine.
“Gabapentin is increasingly used for postoperative pain control to reduce opioid use, although previous research suggested that the analgesic effect of gabapentin is not so great,” Kim informed MedPage Today.
“In our clinical experience on the geriatrics service, we have seen several patients who developed delirium after major surgery and those patients were on gabapentin,” he famous. “We conducted this study to see whether patients receiving gabapentin after surgery were more likely to develop delirium than those not receiving gabapentin.”
“Our findings suggest that routine use of gabapentin for postoperative pain control be avoided,” Kim added. “A careful risk-benefit assessment is needed before prescribing.”
Poorly managed postoperative ache is related to a number of issues, together with cognitive impairment, delirium, despair, decreased mobility, and longer restoration, noticed Zachary Marcum, PharmD, PhD, of the University of Washington in Seattle, and co-authors, in an accompanying editorial.
“Multimodal pain management in the perioperative period is important to minimize the short-term and long-term morbidity associated with opioid use,” the editorialists wrote.
But this research “adds to growing evidence that gabapentin as part of a multimodal pain management approach in the perioperative period is not ideal in older adults because it increases risk of harm with unclear benefits in this population,” Marcum and co-authors identified. “While the use of gabapentin may reduce pain and spare opioids in younger populations, the risks in older adults do not seem to outweigh the benefits.”
The findings are “a call to surgical societies and verification programs aimed to improve surgical care in older adults to specifically address the use of gabapentin in consensus statements, including a clear statement about its currently known risks and benefit,” the editorialists wrote. “More globally, this new clinical evidence invites us to reconsider multimodal pain management pathways for older adults, which will require data-driven non-opioid pain management strategies that can be translated into routine clinical practice.”
Kim and colleagues studied diagnostic codes for sufferers in the Premier Healthcare Database 65 years or older who underwent main surgical procedure at U.S. hospitals inside 7 days of hospital admission from January 2009 to March 2018, and didn’t use gabapentin earlier than surgical procedure.
Of 967,547 sufferers, 119,087 (12.3%) used perioperative gabapentin inside 2 days after surgical procedure. The researchers propensity-score matched 118,936 gabapentin customers and an equal variety of nonusers. Mean age was 74.5, and 62.7% have been girls.
Between postoperative day 3 and hospital discharge, the danger of antagonistic occasions was decrease in gabapentin customers earlier than propensity rating matching, however elevated dangers for delirium, new antipsychotic use, and pneumonia have been seen for gabapentin customers in the matched cohorts.
After matching, the danger variations between gabapentin customers and nonusers have been 0.75 per 100 individuals for delirium, 0.12 per 100 individuals for brand new antipsychotic use, and 0.13 per 100 individuals for pneumonia. There was no elevated danger of hospital demise.
Delirium incidence in this research was decrease than beforehand reported post-surgery incidences of 15% to 25% because of the low sensitivity and excessive specificity of the research’s delirium identification algorithm, Kim and co-authors famous.
“Moreover, the diagnosis codes for delirium and pneumonia did not have an exact onset date in our data sets; thus, these outcomes may have been present before surgery in some patients,” the researchers acknowledged.
This research was supported by grants from the National Institute on Aging.
Kim reported private charges from Alosa Health and VillageMD and grants from NIH; co-authors reported grants from NIH.
Marcum reported no conflicts of curiosity disclosures; a co-author reported relationships with the American Heart Association, the American College of Cardiology, Boston Pepper Center, and the National Institute on Aging.
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