Perioperative Benzodiazepine Prescription Linked to Persistent Use in Surgical Patients

Jason D. Wright, MD

As recent study examined the frequency of use and persistent use of benzodiazepine in patients undergoing major and minor surgery.

Investigators, led by Jason D. Wright, MD, Columbia University College of Physicians and Surgeons, found that a small percentage of surgical patients receive benzodiazepine prescriptions, but 1 in 5 of these patients use the drug persistently.

The team conducted a cohort study of patients aged ≥18 years who underwent 1 of 11 common surgical procedures from 2009 – 2017 in the inpatient or outpatient setting.

Study

Investigators collected data from the Marketscan Database for the analysis.

The database collected claims from nearly 50 million enrollees with commercial insurance from 350 payers and 6 million Medicaid recipients from 12 states.

The team limited the cohort to patients with continuous health insurance from 12 months before the procedure through 6 months after surgical intervention.

They excluded patients who filled a prescription for benzodiazepine during the period from 12 months to 31 days prior to surgery.

However, patients who filled a benzodiazepine prescription in the 30 days before surgery were included as they may have filled it preoperatively or for preoperative indications.

Preoperative benzodiazepine was defined as having filled at least 1 prescription during 30 days before to 14 days after the procedure.

Persistent benzodiazepine use after surgery was defined as having filled 1 or more prescriptions in the period from 90 to 180 days after surgery.

Results

Investigators identified 2,509,599 patients, with a mean age of 54.4 years and 63.6% (1,596,137) women.

Data show the most performed procedure was cataract surgery at 24.6% (618,575) and lobectomy at 10.4% (26.061).

The team noted that perioperative benzodiazepine was used in 63,931 patients (2.6%; 95% CI, 2.53%-2.57%).

Further, the median benzodiazepine supply was found to be 10 days, with 35,088 patients (54.9%) filing a benzodiazepine prescription preoperatively.

The rate of persistent benzodiazepine use was 19.5% (95% CI, 19.2% - 19.8%) among benzodiazepine-naïve patients prescribed the drug.

The data show during the 90 – 180-day period after surgery, 7013 of 12,468 patients (56.2%) received a prescription for benzodiazepines. Further, 5455 (43.8%) received 2 or more prescriptions.

Persistent use among patients prescribed a benzodiazepine were more common in Medicaid recipients versus patients with commercial insurance, with an adjusted rate ratio (aRR) of 1.29 (95% CI, 1.03-1.62).

The commonality was also noted in patients 70 years or older versus those aged 40 years (aRR 1,14, 95% CI 1.05 – 1.23), in women versus men (aRR 1.10, 95% CI, 1.06 – 1.15), in patients with more medical comorbidities (aRR 1.11, 95% CI, 1.04 – 1.19), and in those with diagnoses of anxiety, depression, insomnia, or substance use disorder (aRR 1.43, 95% CI, 1.37 – 1.50).

Conclusion

Investigators concluded raising awareness to curb misuse of benzodiazepine associated with perioperative prescribing is crucial to encourage judicious use after surgery.

They note that data suggest benzodiazepine misuse is becoming an increasingly public health challenge.

“Benzodiazepines should only be used in patients with a clear indication, and attempts should be made to limit the quantity and duration of use,” investigators wrote. “Similar efforts have been successfully used to reduce perioperative opioid prescription use.”

The study, “Association of New Perioperative Benzodiazepine Use with Persistent Benzodiazepine Use,” was published online in JAMA Network Open.