Abstract
BackgroundThe relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.Methods21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.ResultsOf the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.ConclusionIrrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.
Highlights
The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan
Benzodiazepine use during hospital stays is an important factor in the excessive long-term use of these drugs and can be harmful especially to the elderly, who have increased risks of falls and fractures [8,9] and cognitive and memory changes [10,11] that could dramatically decrease their quality of life
When the specific threedigit codes of ICD-10 were analyzed (n > 100), benzodiazepine prescription was most common for patients diagnosed with chronic renal failure (N18, 31.3%), followed by heart failure (I50, 29.3%), acute myocardial infarction (I21, 28.9%), malignant neoplasm of the liver and intrahepatic bile ducts (C22, 28.0%), post-procedural disorders of the nervous system (G97, 28.0%), malignant neoplasm of the bronchus and lung (C34, 27.7%), noninsulin-dependent diabetes mellitus (E11, 25.0%), and malignant neoplasm of the bladder (C67, 22.2%)
Summary
The relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital. BioPsychoSocial Medicine 2009, 3:10 http://www.bpsmedicine.com/content/3/1/10 hospitals and for surgical patients in the absence of appropriate documentation of the indications for their use [37]. Benzodiazepine use during hospital stays is an important factor in the excessive long-term use of these drugs and can be harmful especially to the elderly, who have increased risks of falls and fractures [8,9] and cognitive and memory changes [10,11] that could dramatically decrease their quality of life. It is important to prescribe benzodiazepines for inpatients appropriately, considering the balance of benefit and risk. The study was carried out in accordance with the Declaration of Helsinki (1981) of the World Medical Association. The study protocol was approved by the Ethics Committee of Teikyo University School of Medicine
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