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B154 Perioperative beozodiazepine utilization patterns in major orthopedic surgery
  1. C Cozowicz1,
  2. H Zhong2,
  3. A Illescas2,
  4. V Athanassoglou3,
  5. J Poeran4,
  6. JF Reichel2,
  7. L Poultsides5,
  8. J Liu2 and
  9. SG Memtsoudis2
  1. 1Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  2. 2Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA
  3. 3Oxford University Hospitals, Nuffield Department of Anaesthetics, Oxford, UK
  4. 4Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
  5. 5Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece


Background and Aims Despite important indications benzodiazepine-associated risks may be exacerbated in elderly patients. Given the lack of national data, we aimed to describe perioperative benzodiazepine utilization patterns in total hip/knee arthroplasty (THA/TKA) recipients, an increasingly older and vulnerable population.

Methods Utilizing Premier Healthcare national claims data, we included TKA and THA cases from 2006 to 2019. Benzodiazepine utilization (long- and short-acting agents) was assessed by patient- and healthcare characteristics. Standardized differences signified meaningful differences between groups (defined by value >0.1).

Results Among 1,863,996 TKA and 985,471 THA patients, the utilization of benzodiazepines was 80.5% and 76.1%, respectively. In TKA, 72.6% received short- while 7.9% received long-acting benzodiazepines; respectively 68.4% and 7.7% in THA.

Benzodiazepine use was more frequent among younger and white patients, those on commercial insurance, patients receiving neuraxial or regional anesthesia, multimodal analgesia, in small and medium sized (<=500 beds) hospitals, and in the Midwest; all standardized differences ≥0.1. Similar patterns were observed in THA.

Notably, among patients with benzodiazepine use, in-hospital postoperative opioid administration (in oral morphine equivalents OME) was substantially higher. This was even more pronounced among those receiving long-acting benzodiazepines (median OME with no benzodiazepines utilization 192[IQR 83–345] versus 256[IQR 153–431] with short-, and 329[IQR 195–540] with long-acting benzodiazepines).

Benzodiazepine utilization was persistent high over the past 14 years.

Abstract B154 Table 1
Abstract B154 Table 2

Conclusions In the US, 4 out of 5 patients undergoing major orthopedic surgery receive benzodiazepines perioperatively, despite concerns for neurocognitive recovery. Notably, benzodiazepine utilization was coupled with substantially increased opioid use, potentially indicating implications for perioperative pain management.

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