| アブストラクト | PURPOSE: Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population. METHODS: Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets. Multivariable stratified Cox regression was used to estimate the adjusted hazards ratio (adjHR) with 95% confidence intervals (CI) of community benzodiazepine/z-drug prescribing and falls/trauma-related events, as well as all-cause 30-day rehospitalisation or death. We performed subgroup analyses on patients without pre-critical care admission prescription of benzodiazepines/z-drugs ('treatment-naive'), and sensitivity analyses excluding patients receiving palliative care after discharge. RESULTS: Prescription of benzodiazepines or z-drugs showed no conclusive evidence of increased risk of falls/trauma-related events in the whole cohort (adjHR 1.27; 95%CI 0.76-2.14) or in treatment-naive individuals (adjHR 1.79; 95%CI 0.61-5.26), because estimates lacked precision due to low event rates. For all-cause rehospitalisation or death, benzodiazepines/z-drugs were associated with increased risk (whole cohort adjHR 1.24, 95%CI 1.14-1.36; treatment-naive adjHR 1.66, 95%CI 1.49-1.86). However, after excluding patients treated for palliative care, the association persisted only in treatment-naive individuals (whole cohort adjHR 1.08, 95%CI 0.98-1.19; treatment-naive adjHR 1.42, 95%CI1.25-1.62). CONCLUSIONS: Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group. |
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| 組織名 | Usher Institute, University of Edinburgh, Edinburgh, UK. liz.mansi@ed.ac.uk.;Faculty of Epidemiology and Population Health, London School of Hygiene &;Tropical Medicine, London, UK.;Department of Internal Medicine, Yale School of Medicine, New Haven, USA.;Departments of Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS;Foundation Trust, Sheffield, UK.;Division of Pharmacy and Optometry, School of Health Sciences, Faculty of;Biology, Medicine and Health, The University of Manchester, Manchester, UK.;National Institute for Health and Care Research (NIHR) Greater Manchester Patient;Safety Research Collaboration (PSRC), School of Health Sciences, Faculty of;Biology, Medicine and Health, University of Manchester, Manchester, UK.;Division of Psychiatry, Epidemiology and Applied Clinical Research Department,;University College London, London, UK.;Usher Institute, University of Edinburgh, Edinburgh, UK.;Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK.;University Department of Anaesthesia, Critical Care, and Pain Medicine, School of;Clinical Sciences, University of Edinburgh, Edinburgh, UK. |
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