Association of gabapentinoid utilization with postoperative pulmonary complications in gynecologic surgery: a retrospective cohort study

To investigate gabapentinoid utilization and association with postoperative pulmonary complications after gynecologic surgery. After Institutional Review Board approval, we performed this retrospective cohort study using the Premier Healthcare Database. We used ICD-10 and charge codes to identify adults who underwent elective gynecologic surgery from 2015 to 2018 and received either gabapentin or pregabalin on the day of surgery. Our primary outcome was a composite of pulmonary complications: respiratory failure, pneumonia, reintubation, pulmonary edema, and non-invasive or invasive ventilation. Secondary outcomes included mortality, intensive care unit admission, mechanical or non-invasive ventilation, hospital length of stay, re-admission within 30 days, opioid consumption and antiemetic use. Multivariable generalized linear mixed models were utilized to examine the associations between gabapentinoids and our outcome measures, adjusted for all covariates. Data from 253,013 patients were analyzed, with 19,121 (7.6%) receiving gabapentinoids. Gabapentinoid utilization increased from 3.9% in 2015 to 12.3% in 2018, and was associated with increased pulmonary complications (OR 1.19; 95% CI 1.03–1.38), non-invasive ventilation (odds ratio [OR] 1.53; 95% CI 1.29–1.81), duration of hospital stay (% change 1.75; 95% CI 0.92–2.59), daily antiemetic doses on day of surgery (mean difference [MD] 1.37; 95% CI 1.26–1.49) and subsequently (MD 1.61; 95% CI 1.30–1.99), and higher daily average (MD 4.59 mg; 95% CI 3.55–5.63) and total (MD 8.74 mg; 95% CI 6.83–10.62) parenteral morphine equivalents. Gabapentinoid utilization in gynecologic surgery is increasing and is associated with postoperative pulmonary complications.

本研究旨在探讨妇科手术后加巴喷丁类（gabapentinoid）药物的使用情况，及其与术后肺部并发症的关联。经机构审查委员会（Institutional Review Board）批准，本研究依托Premier医疗数据库开展了一项回顾性队列研究。通过ICD-10编码与收费代码，我们筛选出2015至2018年间接受择期妇科手术、且于手术当日使用加巴喷丁（gabapentin）或普瑞巴林（pregabalin）的成年患者。本研究的主要结局为肺部并发症复合终点，包括呼吸衰竭、肺炎、再插管、肺水肿以及无创/有创通气。次要结局包括死亡率、重症监护病房（intensive care unit, ICU）收治率、有创或无创通气情况、住院时长、30天再入院率、阿片类药物使用量以及止吐药使用情况。本研究采用多变量广义线性混合模型分析加巴喷丁类药物与各结局指标的关联，并对所有协变量进行了校正。最终共纳入253013例患者进行分析，其中19121例（7.6%）使用了加巴喷丁类药物。加巴喷丁类药物的使用率从2015年的3.9%升至2018年的12.3%；使用该类药物与肺部并发症风险升高（比值比（odds ratio, OR）=1.19，95%置信区间（confidence interval, CI）：1.03~1.38）、无创通气需求增加（OR=1.53，95%CI：1.29~1.81）、住院时长延长（变化百分比=1.75，95%CI：0.92~2.59）、手术当日及术后日均止吐药剂量增加（手术当日均差（mean difference, MD）=1.37，95%CI：1.26~1.49；术后MD=1.61，95%CI：1.30~1.99），以及日均肠外吗啡当量更高（MD=4.59mg，95%CI：3.55~5.63）、总肠外吗啡当量更高（MD=8.74mg，95%CI：6.83~10.62）显著相关。妇科手术中加巴喷丁类药物的使用呈上升趋势，且与术后肺部并发症存在关联。