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

Abstract

Objective

To investigate gabapentinoid utilization and association with postoperative pulmonary complications after gynecologic surgery.

Methods

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.

Results

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.

Conclusions

Gabapentinoid utilization in gynecologic surgery is increasing and is associated with postoperative pulmonary complications.

Keywords:

• Gabapentin
• pregabalin
• respiratory depression
• opioids
• sedation

Transparency

Declaration of funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Declaration of financial/other relationships

No potential conflict of interest was reported by the authors. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

H.S.T: conceptualization, methodology, investigation, formal analysis, writing – original draft, review and editing. Z.F.: conceptualization, methodology, investigation, formal analysis, writing – original draft, review and editing. V.K.: conceptualization, methodology, investigation, formal analysis, writing – original draft, review and editing. T.O.: conceptualization, methodology, investigation, formal analysis, writing – original draft, review and editing. K.R.: conceptualization, methodology, investigation, formal analysis, writing – original draft, review and editing. A.S.H.: conceptualization, methodology, investigation, formal analysis, writing – original draft, review, editing and supervision.

Acknowledgements

None.