The Association between General Anesthesia and New Postoperative Uses of Sedative–Hypnotics: A Nationwide Matched Cohort Study

Abstract

Sedative–hypnotic misuse is associated with psychiatric diseases and overdose deaths. It remains uncertain whether types of anesthesia affect the occurrence of new postoperative uses of sedative–hypnotics (NPUSH). We used reimbursement claims data of Taiwan’s National Health Insurance and conducted propensity score matching to compare the risk of NPUSH between general and neuraxial anesthesia among surgical patients who had no prescription of oral sedative–hypnotics or diagnosis of sleep disorders within the 12 months before surgery. The primary outcome was NPUSH within 180 days after surgery. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 92,222 patients were evaluated after matching. Among them, 15,016 (16.3%) had NPUSH, and 2183 (4.7%) were made a concomitant diagnosis of sleep disorders. General anesthesia was significantly associated both with NPUSH (aOR: 1.17, 95% CI: 1.13–1.22, p < 0.0001) and NPUSH with sleep disorders (aOR: 1.11, 95% CI: 1.02–1.21, p = 0.0212) compared with neuraxial anesthesia. General anesthesia was also linked to NPUSH that occurred 90–180 days after surgery (aOR: 1.12, 95% CI: 1.06–1.19, p = 0.0002). Other risk factors for NPUSH were older age, female, lower insurance premium, orthopedic surgery, specific coexisting diseases (e.g., anxiety disorder), concurrent medications (e.g., systemic steroids), postoperative complications, perioperative blood transfusions, and admission to an intensive care unit. Patients undergoing general anesthesia had an increased risk of NPUSH compared with neuraxial anesthesia. This finding may provide an implication in risk stratification and prevention for sedative–hypnotic dependence after surgery.

Systemic Lupus Erythematosus and Risk of Dry Eye Disease and Corneal Surface Damage: A Population-Based Cohort Study

“…The NHI research database contains comprehensive claims data of the insured beneficiaries, including demographic characteristics (e.g., date of birth and sex), medical diagnoses, prescription drugs, and medical expenditures. The NHI research database has been widely used for public health statistics and risk assessment [19][20][21].…”

Anesthetic Concerns in Psychiatric Disease

“…Additionally, 15.2% and 4.9% of patients with new benzodiazepine prescriptions continued to use benzodiazepines for 1 and 8 years after, respectively. Additional risk factors for new postoperative use of benzodiazepines were orthopedic surgery, preexisting malignancy, anxiety disorder, concurrent systemic steroid use, postoperative complications, and admission to ICU, among others [50].…”

The Association between Autoimmune Thyroid Disease and Ocular Surface Damage: A Retrospective Population-Based Cohort Study

“…Taiwan's National Health Insurance program was implemented in March 1995 and covers more than 99% of 23.3 million Taiwanese residents and foreigners working or studying in Taiwan. A detailed description of this database was given in our previous articles [27][28][29]. In this study, we enrolled subjects from the 3 Longitudinal Health Insurance Databases (LHID2000, LHID2005, and LHID2010), which contain original claims data of 1 million randomly sampled beneficiaries from the original NHI research database in the years 2000, 2005, and 2010, respectively [30].…”