• Ana Kowark, Moritz Berger, Rolf Rossaint, Matthias Schmid, Mark Coburn, and POSE-Study group.
• From the Department of Anaesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen (AK), Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn (MB), Department of Anaesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen (RR), Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn (MS), and Department of Anaesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany (MC).
• Eur J Anaesthesiol. 2022 Mar 1; 39 (3): 210218210-218.

BackgroundRecent guidelines suggest that benzodiazepine premedication should be avoided in elderly patients, though with limited supporting evidence.ObjectiveWe conducted a secondary analysis of the POSE data to explore the association of premedication in patients aged 80 years or older with 30-day mortality.DesignWe used propensity score methods to perform a confounder-adjusted time-to-event analysis of the association between benzodiazepine premedication and 30-day mortality of the POSE study.SettingPOSE was conducted as a European multicentre prospective cohort study.PatientsAdults aged 80 years or older scheduled for surgical or nonsurgical intervention under anaesthesia.ResultsA total of 9497 patients were analysed. One thousand five hundred and twenty-one patients received benzodiazepine premedication, 7936 patients received no benzodiazepine premedication, 30 received clonidine and 10 had missing premedication data. Inverse propensity-score-weighted log-rank analysis did not provide unambiguous evidence for an association between benzodiazepine premedication and 30-day mortality; median [range] P = 0.048 [0.044 to 0.078], estimated 30-day mortality rates 3.21% and 4.45% in benzodiazepine-premedicated and nonbenzodiazepine-premedicated patients, respectively. Inverse propensity-score-weighted Cox regression resulted in a hazard ratio of 0.71 (95% CI 0.49 to 1.04), pointing at a possible reduction of 30-day mortality in the benzodiazepine premedication group. Sensitivity analyses, which constituted subgroup, matched-pairs, and subclassification analyses, resulted in similar findings.ConclusionThis secondary analysis of the POSE data did not find evidence for an unambiguous association between benzodiazepine premedication and 30-day mortality. Point estimates indicated a reduction of 30-day mortality in benzodiazepine-premedicated patients. The results presented here might be affected by unmeasured confounding factors, which could be addressed in a randomised trial.Trial RegistrationClinicalTrials.gov Identifier: NCT03152734.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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