Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study
Background: Several studies have investigated the association between benzodiazepine receptor agonist (BZDRA) use during the perioperative period and an elevated incidence of delirium. However, no study has focused on the time course of BZDRA use, including continuation, discontinuation, initiation,...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-01-01
|
| Series: | Comprehensive Psychiatry |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0010440X20300584 |
| _version_ | 1828943107357409280 |
|---|---|
| author | Chie Omichi Nobutaka Ayani Nozomu Oya Yoshihiro Matsumoto Maki Tanaka Takeshi Morimoto Hiroshi Kadotani Jin Narumoto |
| author_facet | Chie Omichi Nobutaka Ayani Nozomu Oya Yoshihiro Matsumoto Maki Tanaka Takeshi Morimoto Hiroshi Kadotani Jin Narumoto |
| author_sort | Chie Omichi |
| collection | DOAJ |
| description | Background: Several studies have investigated the association between benzodiazepine receptor agonist (BZDRA) use during the perioperative period and an elevated incidence of delirium. However, no study has focused on the time course of BZDRA use, including continuation, discontinuation, initiation, and no use. This study aimed to examine the influence of the time course of BZDRA use on post-operative delirium. Methods: This retrospective cohort study was conducted by reviewing medical records. We included patients who were scheduled for surgery under general anesthesia and had been referred to a liaison psychiatrist for pre-operative psychiatric assessment. The patients were classified into four groups based on the pre- and post-operative time course of oral BZDRA use, as follows: continuation, discontinuation, initiation, and no use (never used). The primary outcome was the prevalence of post-operative delirium in non-intensive care unit settings. We also performed stratified analyses according to age, the presence of cognitive impairment, the presence of delirium history, and antipsychotic drug use on admission. Results: Among 250 patients, 78 (31%) developed post-operative delirium. The Discontinuation group had a higher rate of delirium (49%, 24/49) than the other groups (Continuation [14%, 4/29]; Initiation [38%, 3/8], Never used [29%, 47/164], p = 0.008). Conclusions: Abrupt discontinuation of BZDRAs during the perioperative period may be a risk factor for post-operative delirium and should therefore be avoided. |
| first_indexed | 2024-12-14T04:08:42Z |
| format | Article |
| id | doaj.art-1a26b45f07cd4b3cbd536ce03390f798 |
| institution | Directory Open Access Journal |
| issn | 0010-440X |
| language | English |
| last_indexed | 2024-12-14T04:08:42Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Comprehensive Psychiatry |
| spelling | doaj.art-1a26b45f07cd4b3cbd536ce03390f7982022-12-21T23:17:45ZengElsevierComprehensive Psychiatry0010-440X2021-01-01104152216Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort studyChie Omichi0Nobutaka Ayani1Nozomu Oya2Yoshihiro Matsumoto3Maki Tanaka4Takeshi Morimoto5Hiroshi Kadotani6Jin Narumoto7Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, JapanDepartment of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Department of Psychiatry, National Hospital Organization, Maizuru Medical Center, 2410 Yukinaga, Maizuru, Kyoto 625-8502, Japan; Corresponding author at: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, JapanDepartment of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, JapanDepartment of Medical Safety Management, University Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, JapanDepartment of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, JapanDepartment of Sleep and Behavioral Sciences, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga 520-2192, JapanDepartment of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, JapanBackground: Several studies have investigated the association between benzodiazepine receptor agonist (BZDRA) use during the perioperative period and an elevated incidence of delirium. However, no study has focused on the time course of BZDRA use, including continuation, discontinuation, initiation, and no use. This study aimed to examine the influence of the time course of BZDRA use on post-operative delirium. Methods: This retrospective cohort study was conducted by reviewing medical records. We included patients who were scheduled for surgery under general anesthesia and had been referred to a liaison psychiatrist for pre-operative psychiatric assessment. The patients were classified into four groups based on the pre- and post-operative time course of oral BZDRA use, as follows: continuation, discontinuation, initiation, and no use (never used). The primary outcome was the prevalence of post-operative delirium in non-intensive care unit settings. We also performed stratified analyses according to age, the presence of cognitive impairment, the presence of delirium history, and antipsychotic drug use on admission. Results: Among 250 patients, 78 (31%) developed post-operative delirium. The Discontinuation group had a higher rate of delirium (49%, 24/49) than the other groups (Continuation [14%, 4/29]; Initiation [38%, 3/8], Never used [29%, 47/164], p = 0.008). Conclusions: Abrupt discontinuation of BZDRAs during the perioperative period may be a risk factor for post-operative delirium and should therefore be avoided.http://www.sciencedirect.com/science/article/pii/S0010440X20300584benzodiazepine receptor agonistpost-operative deliriumdiscontinuationconsultation-liaison psychiatrybenzodiazepine withdrawal syndrome |
| spellingShingle | Chie Omichi Nobutaka Ayani Nozomu Oya Yoshihiro Matsumoto Maki Tanaka Takeshi Morimoto Hiroshi Kadotani Jin Narumoto Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study Comprehensive Psychiatry benzodiazepine receptor agonist post-operative delirium discontinuation consultation-liaison psychiatry benzodiazepine withdrawal syndrome |
| title | Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study |
| title_full | Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study |
| title_fullStr | Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study |
| title_full_unstemmed | Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study |
| title_short | Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study |
| title_sort | association between discontinuation of benzodiazepine receptor agonists and post operative delirium among inpatients with liaison intervention a retrospective cohort study |
| topic | benzodiazepine receptor agonist post-operative delirium discontinuation consultation-liaison psychiatry benzodiazepine withdrawal syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S0010440X20300584 |
| work_keys_str_mv | AT chieomichi associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT nobutakaayani associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT nozomuoya associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT yoshihiromatsumoto associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT makitanaka associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT takeshimorimoto associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT hiroshikadotani associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy AT jinnarumoto associationbetweendiscontinuationofbenzodiazepinereceptoragonistsandpostoperativedeliriumamonginpatientswithliaisoninterventionaretrospectivecohortstudy |