Preoperative History of Gabapentinoids Use is Associated with Longer Length of Hospital Stay in Patients Undergoing Lower Extremity Bypass Surgery for Severe Peripheral Artery Disease

Background

This study aimed to assess the association of preoperative gabapentinoids (GBP) use with the postoperative length of stay for patients undergoing peripheral artery lower extremity bypass (LEB) surgery for lifestyle-limiting claudication and chronic limb-threatening ischemia at a tertiary care hospital.

Methods

Patients undergoing LEB surgery during the period between 2000 and 2020 at Penn State Health Milton S. Hershey Medical Center were stratified into 2 groups based on the preoperative use of prescribed GBPs (GBPs versus no GBPs). Patients' preoperative characteristics, comorbidities and medications were assessed, and the outcomes of interest were analyzed in univariate analysis, stratified analysis, and by multivariable regression models. Primary outcomes were 30-day mortality and length of stay. The secondary outcomes included readmissions, unplanned return to the operating room, amputation, myocardial infarction, cerebrovascular accident, pneumonia, pulmonary embolism, urinary tract infections, wound complications, acute congestive heart failure exacerbation and nonhome discharge. A P value of <0.05 was considered significant for all the analyses.

Results

The study cohort comprised 359 patients. The GBPs group comprised 125 patients with a mean (standard deviation) age of 61.6 (±10.2) years and the no-GBPs group consisted of 234 patients with a mean (standard deviation) age of 64.6 (±12.2) years. Patients in GBPs group were likely to be younger (P = 0.014), undergo LEB for chronic limb-threatening ischemia (P = 0.039), and have insulin-dependent diabetes mellitus (P < 0.001) than the no-GBPs group. In terms of outcomes, the patients in the GBPs group were more likely to have longer postoperative length of stay (9.3 ± 11.1 vs. 6.4 ± 5.0 days no GBPs, P = 0.008). In multivariable analysis, the patients in the GBPs group had 92% (adjusted odds ratio 1.92 [1.16, 3.18], P = 0.01) increase in the odds of having a length of stay above 6-day calculated median in comparison to the no-GBPs group.

Conclusion

This retrospective analysis of patients undergoing LEB at a tertiary care hospital shows a significant association between preoperative GBPs use and the longer postoperative length of stay. This study bridges a gap in the current body of knowledge regarding the association of GBP use with the postoperative outcomes in patients undergoing LEB for severe peripheral artery disease.