苯二氮䓬类药物预给药与 30 天死亡率的关系：老年人围手术期结局研究（POSE）的倾向评分加权分析。
Association between benzodiazepine premedication and 30-day mortality rate: A propensity-score weighted analysis of the Peri-interventional Outcome Study in the Elderly (POSE).
机构信息
From the Department of Anaesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen (AK), Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn (MB), Department of Anaesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen (RR), Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn (MS), and Department of Anaesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany (MC).
出版信息
Eur J Anaesthesiol. 2022 Mar 1;39(3):210-218. doi: 10.1097/EJA.0000000000001638.
BACKGROUND
Recent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients, though with limited supporting evidence.
OBJECTIVE
We conducted a secondary analysis of the POSE data to explore the association of premedication in patients aged 80 years or older with 30-day mortality.
DESIGN
We used propensity score methods to perform a confounder-adjusted time-to-event analysis of the association between benzodiazepine premedication and 30-day mortality of the POSE study.
SETTING
POSE was conducted as a European multicentre prospective cohort study.
PATIENTS
Adults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.
RESULTS
A total of 9497 patients were analysed. One thousand five hundred and twenty-one patients received benzodiazepine premedication, 7936 patients received no benzodiazepine premedication, 30 received clonidine and 10 had missing premedication data. Inverse propensity-score-weighted log-rank analysis did not provide unambiguous evidence for an association between benzodiazepine premedication and 30-day mortality; median [range] P = 0.048 [0.044 to 0.078], estimated 30-day mortality rates 3.21% and 4.45% in benzodiazepine-premedicated and nonbenzodiazepine-premedicated patients, respectively. Inverse propensity-score-weighted Cox regression resulted in a hazard ratio of 0.71 (95% CI 0.49 to 1.04), pointing at a possible reduction of 30-day mortality in the benzodiazepine premedication group. Sensitivity analyses, which constituted subgroup, matched-pairs, and subclassification analyses, resulted in similar findings.
CONCLUSION
This secondary analysis of the POSE data did not find evidence for an unambiguous association between benzodiazepine premedication and 30-day mortality. Point estimates indicated a reduction of 30-day mortality in benzodiazepine-premedicated patients. The results presented here might be affected by unmeasured confounding factors, which could be addressed in a randomised trial.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03152734.
背景
最近的指南建议避免在老年患者中使用苯二氮䓬类药物进行术前用药，但支持证据有限。
目的
我们对 POSE 数据进行了二次分析，以探讨 80 岁或以上患者术前用药与 30 天死亡率之间的关系。
设计
我们使用倾向评分方法对 POSE 研究中苯二氮䓬类药物术前用药与 30 天死亡率之间的关联进行了混杂因素调整的生存时间分析。
设置
POSE 是一项欧洲多中心前瞻性队列研究。
患者
计划在麻醉下接受手术或非手术干预的 80 岁或以上成年人。
结果
共分析了 9497 例患者。1521 例患者接受了苯二氮䓬类药物术前用药，7936 例患者未接受苯二氮䓬类药物术前用药，30 例患者接受了可乐定，10 例患者术前用药数据缺失。逆倾向评分加权对数秩分析并未提供苯二氮䓬类药物术前用药与 30 天死亡率之间明确关联的证据；中值[范围]P=0.048[0.044 至 0.078]，苯二氮䓬类药物术前用药和非苯二氮䓬类药物术前用药患者的估计 30 天死亡率分别为 3.21%和 4.45%。逆倾向评分加权 Cox 回归得出的风险比为 0.71（95%CI0.49 至 1.04），提示苯二氮䓬类药物术前用药组 30 天死亡率可能降低。构成亚组、匹配对和分类亚组分析的敏感性分析得出了类似的结果。
结论
对 POSE 数据的二次分析并未发现苯二氮䓬类药物术前用药与 30 天死亡率之间明确关联的证据。点估计表明，苯二氮䓬类药物术前用药患者的 30 天死亡率降低。这里呈现的结果可能受到未测量混杂因素的影响，可以在随机试验中解决。
试验注册
ClinicalTrials.gov 标识符：NCT03152734。
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