Abstract：
BACKGROUND: Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain.
METHODS: This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009-2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes.
RESULTS: The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7-1.2]; RD [95% CI] per 100 persons, -0.3 [-1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7-1.1]; RD [95% CI] per 100 persons, -0.5 [-1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups.
CONCLUSIONS: Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.
METHODS: This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009-2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes.
RESULTS: The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7-1.2]; RD [95% CI] per 100 persons, -0.3 [-1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7-1.1]; RD [95% CI] per 100 persons, -0.5 [-1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups.
CONCLUSIONS: Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.
摘要：
背景：睡眠辅助通常用于治疗睡眠障碍，老年患者术后谵妄的一个可改变的危险因素。褪黑素受体激动剂在术后期间的使用一直在增加。褪黑激素受体激动剂的比较安全性，唑吡坦,和替马西泮仍然不确定。
方法：这项回顾性研究包括22,083名≥65岁的患者，他们开始使用褪黑激素受体激动剂，唑吡坦,或替马西泮在2009-2018年PremierHealthcare数据库中的大手术后。我们进行了基于倾向评分的重叠加权，并估计了术后谵妄的风险比（RR）和风险差（RD）作为主要结果，以及谵妄或新的抗精神病药开始的复合结果。肺炎,和住院死亡率作为次要结局。
结果：研究人群的平均年龄为78岁（SD，7）年和50％是女性。使用褪黑素受体激动剂治疗的患者术后谵妄的风险没有显着差异（3.4％，参考组)，唑吡坦（2.9%；RR[95%CI]，0.9[0.7-1.2];每100人RD[95%CI],-0.3[-1.1至0.6])，和替马西泮（3.1%；0.9[0.7-1.1]；每100人RD[95%CI]，-0.5[-1.2至0.3])。谵妄或新的抗精神病药物的风险，肺炎,所有组的住院死亡率也相似.
结论：与唑吡坦和替马西泮相比，褪黑素受体激动剂在大手术后的老年人术后谵妄和其他不良结局的风险较低。
方法：这项回顾性研究包括22,083名≥65岁的患者，他们开始使用褪黑激素受体激动剂，唑吡坦,或替马西泮在2009-2018年PremierHealthcare数据库中的大手术后。我们进行了基于倾向评分的重叠加权，并估计了术后谵妄的风险比（RR）和风险差（RD）作为主要结果，以及谵妄或新的抗精神病药开始的复合结果。肺炎,和住院死亡率作为次要结局。
结果：研究人群的平均年龄为78岁（SD，7）年和50％是女性。使用褪黑素受体激动剂治疗的患者术后谵妄的风险没有显着差异（3.4％，参考组)，唑吡坦（2.9%；RR[95%CI]，0.9[0.7-1.2];每100人RD[95%CI],-0.3[-1.1至0.6])，和替马西泮（3.1%；0.9[0.7-1.1]；每100人RD[95%CI]，-0.5[-1.2至0.3])。谵妄或新的抗精神病药物的风险，肺炎,所有组的住院死亡率也相似.
结论：与唑吡坦和替马西泮相比，褪黑素受体激动剂在大手术后的老年人术后谵妄和其他不良结局的风险较低。
