Postoperative use of sleep aids and delirium in older adults after major surgery: A retrospective cohort study

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-07-09 DOI:10.1111/jgs.19067

Su Been Lee BA, Chan Mi Park MD, MPH, Raisa Levin MS, Dae Hyun Kim MD, ScD

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引用次数: 0

Abstract

Background

Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain.

Methods

This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009–2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes.

Results

The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7–1.2]; RD [95% CI] per 100 persons, −0.3 [−1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7–1.1]; RD [95% CI] per 100 persons, −0.5 [−1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups.

Conclusions

Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.

查看原文本刊更多论文

老年人大手术后使用助眠药物与谵妄：一项回顾性队列研究。

背景：睡眠障碍是导致老年患者术后谵妄的一个可改变的风险因素，助眠剂是治疗睡眠障碍的常用处方。术后使用褪黑素受体激动剂的情况越来越多。褪黑素受体激动剂、唑吡坦和替马西泮的安全性比较仍不确定：这项回顾性研究纳入了 Premier Healthcare 数据库（2009-2018 年）中 22,083 名年龄≥65 岁、在大手术后开始使用褪黑素受体激动剂、唑吡坦或替马西泮的患者。我们进行了基于倾向评分的重叠加权，并估算了术后谵妄作为主要结局的风险比（RR）和风险差（RD），以及作为次要结局的谵妄或新的抗精神病药物启动、肺炎和院内死亡率的复合风险比（RR）和风险差（RD）：研究对象的平均年龄为 78（SD，7）岁，50% 为女性。使用褪黑素受体激动剂（3.4%，参照组）、唑吡坦（2.9%; RR [95% CI], 0.9 [0.7-1.2]; RD [95% CI] per 100 persons, -0.3 [-1.1 to 0.6]）和替马西泮（3.1%; 0.9 [0.7-1.1]; RD [95% CI] per 100 persons, -0.5 [-1.2 to 0.3]）。各组患者出现谵妄或开始使用新的抗精神病药物、肺炎和院内死亡的风险也相似：结论：与唑吡坦和替马西泮相比，褪黑素受体激动剂与老年人大手术后较低的术后谵妄风险和其他不良后果无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.