Association between benzodiazepine premedication and 30-day mortality rate: A propensity-score weighted analysis of the Peri-interventional Outcome Study in the Elderly (POSE)
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
- University of Bonn Medical Center
Abstract
BACKGROUND: Recent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients, though with limited supporting evidence.
OBJECTIVE: We conducted a secondary analysis of the POSE data to explore the association of premedication in patients aged 80 years or older with 30-day mortality.
DESIGN: We used propensity score methods to perform a confounder-adjusted time-to-event analysis of the association between benzodiazepine premedication and 30-day mortality of the POSE study.
SETTING: POSE was conducted as a European multicentre prospective cohort study.
PATIENTS: Adults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.
RESULTS: A total of 9497 patients were analysed. One thousand five hundred and twenty-one patients received benzodiazepine premedication, 7936 patients received no benzodiazepine premedication, 30 received clonidine and 10 had missing premedication data. Inverse propensity-score-weighted log-rank analysis did not provide unambiguous evidence for an association between benzodiazepine premedication and 30-day mortality; median [range] P = 0.048 [0.044 to 0.078], estimated 30-day mortality rates 3.21% and 4.45% in benzodiazepine-premedicated and nonbenzodiazepine-premedicated patients, respectively. Inverse propensity-score-weighted Cox regression resulted in a hazard ratio of 0.71 (95% CI 0.49 to 1.04), pointing at a possible reduction of 30-day mortality in the benzodiazepine premedication group. Sensitivity analyses, which constituted subgroup, matched-pairs, and subclassification analyses, resulted in similar findings.
CONCLUSION: This secondary analysis of the POSE data did not find evidence for an unambiguous association between benzodiazepine premedication and 30-day mortality. Point estimates indicated a reduction of 30-day mortality in benzodiazepine-premedicated patients. The results presented here might be affected by unmeasured confounding factors, which could be addressed in a randomised trial.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03152734.
Details
Original language | English |
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Pages (from-to) | 210-218 |
Number of pages | 9 |
Journal | European journal of anaesthesiology |
Volume | 39 |
Issue number | 3 |
Early online date | 25 Nov 2021 |
Publication status | Published - 1 Mar 2022 |
Peer-reviewed | Yes |
Externally published | Yes |
External IDs
PubMedCentral | PMC8815825 |
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Scopus | 85124056194 |
Keywords
Keywords
- Adult, Aged, Aged, 80 and over, Benzodiazepines/adverse effects, Humans, Outcome Assessment, Health Care, Premedication, Propensity Score, Prospective Studies