한빛사논문
- 조회408
Dae Hyun Kim 1, Su Been Lee 2, Chan Mi Park 3, Raisa Levin 2, Eran Metzger 3, Brian T Bateman 4, E Wesley Ely 5, Pratik P Pandharipande 6, Margaret A Pisani 7, Richard N Jones 8, Edward R Marcantonio 9, Sharon K Inouye 10
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston; and Harvard Medical School, Boston, Massachusetts (D.H.K.).
2Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts (S.B.L., R.L.).
3Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston; and Harvard Medical School, Boston, Massachusetts (C.M.P., E.M.).
4Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California (B.T.B.).
5Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (E.W.E.).
6Division of Anesthesiology Critical Care Medicine, Departments of Anesthesiology and Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (P.P.P.).
7Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut (M.A.P.).
8Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (R.N.J.).
9Division of Gerontology, Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston; and Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.).
10Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston; and Harvard Medical School, Boston, Massachusetts (S.K.I.).
Corresponding author : Dae Hyun Kim
Abstract
Background: Antipsychotics are commonly used to manage postoperative delirium. Recent studies reported that haloperidol use has declined, and atypical antipsychotic use has increased over time.
Objective: To compare the risk for in-hospital adverse events associated with oral haloperidol, olanzapine, quetiapine, and risperidone in older patients after major surgery.
Design: Retrospective cohort study.
Setting: U.S. hospitals in the Premier Healthcare Database.
Patients: 17 115 patients aged 65 years and older without psychiatric disorders who were prescribed an oral antipsychotic drug after major surgery from 2009 to 2018.
Interventions: Haloperidol (≤4 mg on the day of initiation), olanzapine (≤10 mg), quetiapine (≤150 mg), and risperidone (≤4 mg).
Measurements: The risk ratios (RRs) for in-hospital death, cardiac arrhythmia events, pneumonia, and stroke or transient ischemic attack (TIA) were estimated after propensity score overlap weighting.
Results: The weighted population had a mean age of 79.6 years, was 60.5% female, and had in-hospital death of 3.1%. Among the 4 antipsychotics, quetiapine was the most prescribed (53.0% of total exposure). There was no statistically significant difference in the risk for in-hospital death among patients treated with haloperidol (3.7%, reference group), olanzapine (2.8%; RR, 0.74 [95% CI, 0.42 to 1.27]), quetiapine (2.6%; RR, 0.70 [CI, 0.47 to 1.04]), and risperidone (3.3%; RR, 0.90 [CI, 0.53 to 1.41]). The risk for nonfatal clinical events ranged from 2.0% to 2.6% for a cardiac arrhythmia event, 4.2% to 4.6% for pneumonia, and 0.6% to 1.2% for stroke or TIA, with no statistically significant differences by treatment group.
Limitation: Residual confounding by delirium severity; lack of untreated group; restriction to oral low-to-moderate dose treatment.
Conclusion: These results suggest that atypical antipsychotics and haloperidol have similar rates of in-hospital adverse clinical events in older patients with postoperative delirium who receive an oral low-to-moderate dose antipsychotic drug.
논문정보
- Research article
- 2023년 09월 (BRIC 등록일 2023-10-06)
- 국외 연구진
- 의약학 > 응용의학
댓글 작성 로그인
팝업 닫기관련 링크
관련분야 연구자보기
소속기관 논문보기
관련분야 논문보기
해당논문 저자보기
