Background and Aims Midazolam, the gold standard preoperative sedative, can be associated with serious neurocognitive and respiratory side effects. Given the paucity of population level data we aimed to determine the impact of benzodiazepine utilization on postoperative outcomes.
Methods Total knee and hip arthroplasty (TKA/THA) recipients were identified from Premier Healthcare national claims data (2006–2019). Multivariable logistic regression models to determine if midazolam was a predictor of postoperative cardiac, pulmonary complications, delirium, and in-hospital falls.
Results Among overall 2,848,897 patients, more than 75% received midazolam perioperatively. This was associated with increased odds for in-hospital falls in TKA/THA (OR 1.1, CI 1.07, 1.14)/(OR 1.1, CI 1.06, 1.16), while decreases odds for cardiac (OR 0.94, CI 0.91, 0.97)/(OR 0.93, CI 0.89, 0.97), and pulmonary complications (OR 0.92, CI 0.87, 0,96) was observed in THA. No difference in the occurrence of postoperative delirium was found with benzodiazepine use. Notably, concurrent use of benzodiazepines and gabapentinoids significantly increased the odds for postoperative complications. This was evident in more frequent pulmonary complications (OR 1.22, CI 1.18, 1.27)/(OR 1.29, CI 1.22, 1.37), naloxone utilization, (OR 1.56, CI 1.51, 1.60)/(OR 1.49, CI 1.42, 1.56), and substantially higher odds for postoperative delirium (OR 1.45, CI 1.38, 1.52)/(OR 1.32, CI 1.23, 1.34) in THA/TKA, respectively.
Conclusions Perioperative benzodiazepines use was associated with increases patient falls, no effect for delirium occurrence, and reduced cardiac complications. Importantly, the postoperative risk profile, substantially deteriorated with concurrent use of gabapentinoids, showing a substantial increase in respiratory failure and delirium.
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