Association between benzodiazepine premedication and 30-day mortality rate A propensity-score weighted analysis of the Peri-interventional Outcome Study in the Elderly (POSE)

Kowark A., Berger M., Rossaint R., Schmid M., Coburn M.

EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol.39, no.3, pp.210-218, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 39 Issue: 3
  • Publication Date: 2022
  • Doi Number: 10.1097/eja.0000000000001638
  • Journal Name: EUROPEAN JOURNAL OF ANAESTHESIOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.210-218
  • Istanbul University Affiliated: No

Abstract

BACKGROUNDRecent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients, though with limited supporting evidence.OBJECTIVEWe 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.DESIGNWe 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.SETTINGPOSE was conducted as a European multicentre prospective cohort study.PATIENTSAdults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.RESULTSA 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.CONCLUSIONThis 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.