Association between preoperative administration of gabapentinoids and 30-day hospital readmission: A retrospective hospital registry study.

Abstract

Study objectiveTo evaluate the effectiveness of preoperative gabapentinoid administration. DesignRetrospective hospital registry study. SettingTertiary referral center (Boston, MA). Patients111,008 adult non-emergency, non-cardiac surgical patients between 2014 and 2018. InterventionsPreoperative administration of gabapentinoids (gabapentin or pregabalin). MeasurementsWe tested the primary hypothesis that preoperative gabapentinoid use was associated with lower odds of hospital readmission within 30 days. Contingent on this hypothesis, we examined whether lower intraoperative opioid utilization mediated this effect. Secondary outcome was postoperative respiratory complications. Main resultsGabapentinoid administration was associated with lower odds of readmission (adjusted odds ratio [ORadj] 0.80 [95% CI, 0.75–0.85]; p < 0.001). This effect was in part mediated by lower intraoperative opioid utilization in patients receiving gabapentinoids (8.2% [2.4–11.5%]; p = 0.012). Readmissions for gastrointestinal disorders (ORadj 0.74 [0.60–0.90]; p = 0.003), neuro-psychiatric complications (ORadj 0.66 [0.49–0.87]; p = 0.004), non-surgical site infections (ORadj 0.68 [0.52–0.88; p = 0.004) and trauma or poisoning (ORadj 0.25 [0.16–0.41]; p < 0.001) occurred less frequently in patients receiving gabapentinoids. The risk of postoperative respiratory complications was lower in patients receiving gabapentinoids (ORadj 0.77 [0.70–0.85]; p < 0.001). Lower doses of pregabalin (< 75 mg) and gabapentin (< 300 mg) compared to both, no and high-dose administration of gabapentinoids, were associated with a lower risk of postoperative respiratory complications (ORadj 0.61 [0.50–0.75]; p < 0.001 and ORadj 0.70 [0.53–0.92]; p = 0.012, respectively). These lower gabapentinoid doses prevented 30-day readmission (ORadj 0.74 [0.65–0.85]; p < 0.001). The results were robust in several sensitivity analyses including surgical procedure defined subgroups and patients undergoing ambulatory surgery. ConclusionsThe preoperative use of pregabalin and gabapentin, up to doses of 75 and 300 mg respectively, mitigates the risks of hospital readmission and postoperative respiratory complications which can in part be explained by lower intraoperative opioid use. Further research is warranted to elucidate mechanisms of the preventive action.