Gabapentin after surgery increases risk in the elderly

A retrospective study showed that gabapentin perioperatively increased the risk of delirium, new use of antipsychotics, and pneumonia in older adults after major surgery.

The risk of developing delirium – the primary study outcome – was 3.4% for older patients who received gabapentin within 2 days after major surgery and 2.6% for those who did not, with a relative risk (RR) of 1.28 (95% CI) 1.23-1.34 Dae Hyun Kim, MD, ScD, of Brigham & Women’s Hospital and Hebrew SeniorLife in Boston, and colleagues report.

The risk of new use of antipsychotics was 0.8% versus 0.7%, respectively (RR 1.17, 95% CI 1.07-1.29), and the risk of developing pneumonia was 1.3% versus 1.2% (RR 1.11 95% CI 1.03-1.20), the researchers reported in JAMA Internal Medicine.

“Gabapentin is increasingly used to control pain after surgery to reduce opioid use, although previous research suggests that the analgesic effect of gabapentin is not significant,” Kim said. MedPage today.

“In our clinical experience in a geriatric service, we saw many patients who developed delirium after major surgery and these patients were taking gabapentin,” he noted. “We conducted this study to see if patients who received gabapentin after surgery were more likely to develop delirium than those who did not receive gabapentin.”

“Our findings suggest that routine use of gabapentin should be avoided for postoperative pain control,” Kim added. “A careful assessment of the risks and benefits is needed before a drug can be prescribed.”

Poorly controlled postoperative pain is associated with many complications, including cognitive impairment, delirium, depression, decreased mobility, and longer recovery, notes Zachary Marcum, MD, PhD, of the University of Washington in Seattle. , and co-authors, in accompanying opening.

The editors wrote: “Multimodal perioperative pain management is important for reducing short- and long-term morbidity associated with opioid use.”

But this study “adds to the growing evidence that gabapentin as part of a multimodal perioperative pain management approach is not optimal in the elderly because it increases the risk of harm with unclear benefits for this population,” Markum and co-authors noted. “While gabapentin use may reduce pain and reduce opioid intake in younger populations, the risks in older adults do not appear to outweigh the benefits.”

The editors wrote that the findings are “a call for surgical societies and validation programs aimed at improving surgical care in the elderly to specifically address the use of gabapentin in the consensus data, including a clear statement about its currently known risks and benefits.” “Globally, this new clinical evidence invites us to reconsider multimodal pain management pathways for older adults, which will require data-driven, non-opioid pain management strategies that can be translated into routine clinical practice.”

Kim and colleagues studied the diagnostic codes of patients in the Premier Healthcare database aged 65 or older who had undergone major surgery in US hospitals within 7 days of hospitalization from January 2009 to March 2018, and had not used gabapentin prior to surgery.

Of the 967,547 patients, 119,087 (12.3%) used gabapentin perioperatively within 2 days after surgery. The researchers’ slope score corresponded to 118,936 gabapentin users and an equal number of non-users. The mean age was 74.5%, and the women were 62.7%.

Between the third postoperative day and hospital discharge, the risk of adverse events was lower in gabapentin users before matching propensity score, but increased risks of delirium and new use of antipsychotics and pneumonia were observed for gabapentin users in the matched cohorts.

After matching, the risk differences between gabapentin users and nonusers were 0.75 per 100 people for delirium, 0.12 per 100 people for new antipsychotic use, and 0.13 per 100 people for pneumonia. There was no increased risk of death in hospital.

The incidence of delirium in this study was 15% to 25% lower than previously reported postoperative cases due to the low sensitivity and high specificity of the study’s delirium identification algorithm, note Kim and co-authors.

The researchers acknowledged that “further, the diagnostic codes for delirium and pneumonia did not have a definite onset date in our datasets; thus, these findings may be present before surgery in some patients.”

  • Judy George Covers neuroscience and neuroscience news for MedPage Today, and writes about brain aging, Alzheimer’s disease, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s disease, amyotrophic lateral sclerosis, concussion, and CTE , sleep, pain, and more. Follow

Disclosures

This study was supported by grants from the National Institute on Aging.

Kim reported personal fees from Alosa Health and VillageMD and grants from the National Institutes of Health; Co-authors reported grants from the National Institutes of Health.

Marcom reported no conflict of interest; A co-author has reported relationships with the American Heart Association, the American College of Cardiology, the Boston Paper Center, and the National Institute on Aging.