دورية أكاديمية
Comparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery : A Nationwide Cohort Study.
| العنوان: | Comparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery : A Nationwide Cohort Study. |
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| المؤلفون: | Kim DH; Division 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.)., Lee SB; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts (S.B.L., R.L.)., Park CM; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston; and Harvard Medical School, Boston, Massachusetts (C.M.P., E.M.)., Levin R; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts (S.B.L., R.L.)., Metzger E; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston; and Harvard Medical School, Boston, Massachusetts (C.M.P., E.M.)., Bateman BT; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California (B.T.B.)., Ely EW; Division 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.)., Pandharipande PP; Division of Anesthesiology Critical Care Medicine, Departments of Anesthesiology and Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (P.P.P.)., Pisani MA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut (M.A.P.)., Jones RN; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (R.N.J.)., Marcantonio ER; Division 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.)., Inouye SK; 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 (S.K.I.). |
| المصدر: | Annals of internal medicine [Ann Intern Med] 2023 Sep; Vol. 176 (9), pp. 1153-1162. Date of Electronic Publication: 2023 Sep 05. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: American College of Physicians--American Society of Internal Medicine Country of Publication: United States NLM ID: 0372351 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-3704 (Electronic) Linking ISSN: 00034819 NLM ISO Abbreviation: Ann Intern Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2001->: Philadelphia, PA : American College of Physicians--American Society of Internal Medicine Original Publication: Philadelphia [etc.] American College of Physicians. |
| مواضيع طبية MeSH: | Antipsychotic Agents*/adverse effects , Emergence Delirium* , Ischemic Attack, Transient*, Humans ; Female ; Aged ; Male ; Quetiapine Fumarate/adverse effects ; Haloperidol/adverse effects ; Olanzapine ; Risperidone ; Cohort Studies ; Hospital Mortality ; Retrospective Studies ; Hospitals |
| مستخلص: | 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. Primary Funding Source: National Institute on Aging. Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3021. |
| التعليقات: | Comment in: Ann Intern Med. 2023 Dec;176(12):JC141. (PMID: 38048583) |
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| معلومات مُعتمدة: | R01 AG062713 United States AG NIA NIH HHS; K24 AG035075 United States AG NIA NIH HHS; P01 AG031720 United States AG NIA NIH HHS; R01 AG056368 United States AG NIA NIH HHS; R33 AG071744 United States AG NIA NIH HHS; R01 AG071809 United States AG NIA NIH HHS; R01 AG030618 United States AG NIA NIH HHS; R01 AG044518 United States AG NIA NIH HHS; K24 AG073527 United States AG NIA NIH HHS |
| المشرفين على المادة: | 0 (Antipsychotic Agents) 2S3PL1B6UJ (Quetiapine Fumarate) J6292F8L3D (Haloperidol) N7U69T4SZR (Olanzapine) L6UH7ZF8HC (Risperidone) |
| تواريخ الأحداث: | Date Created: 20230904 Date Completed: 20230920 Latest Revision: 20240306 |
| رمز التحديث: | 20240306 |
| مُعرف محوري في PubMed: | PMC10625498 |
| DOI: | 10.7326/M22-3021 |
| PMID: | 37665998 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1539-3704 |
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| DOI: | 10.7326/M22-3021 |