Adverse Events Associated with Antipsychotic Use in Hospitalized Older Adults After Cardiac Surgery

摘要

Objectives To evaluate in‐hospital adverse events associated with typical and atypical antipsychotic medications ( APM s) after cardiac surgery. Design Retrospective cohort study. Setting Nationwide inpatient database, 2003 to 14. Participants Individuals (mean age 70) newly treated with oral atypical (n = 2,580) or typical (n = 1,126 APM s) after coronary artery bypass grafting or valve surgery (N = 3,706). Measurements In‐hospital mortality, arrhythmia, pneumonia, use of brain imaging (surrogate for oversedation and neurological events), and length of stay after drug initiation Results In the propensity score–matched cohort, median treatment duration was 3 days (interquartile range ( IQR ) 1–6 days) for atypical APM s and 2 days ( IQR 1–3 days) for typical APMs. There were no large differences in in‐hospital mortality (atypical 5.4%, typical 5.3%; risk difference ( RD ) = 0.1%, 95% confidence interval ( CI ) = ?2.1 to 2.3%), arrhythmia (2.0% vs 2.2%; RD = 0.0%; 95% CI = ?1.4 to 1.4%), pneumonia (16.1% vs 14.5%; RD = 1.6%, 95% CI = ?1.9 to 5.0%), and length of stay (9.9 days vs 9.3 days; mean difference = 0.5 days, 95% CI = ?1.2 to 2.2). Use of brain imaging was more common after initiating atypical APM s (17.3%) than after typical APM s (12.4%; RD = 4.9%, 95% CI = 1.4–8.4). Conclusion In hospitalized individuals who underwent cardiac surgery, short‐term use of typical APM s was associated with risks of adverse events similar to those with atypical APM s. Moreover, greater use of brain imaging associated with atypical APM s suggests that these drugs may cause oversedation or adverse neurological events. Because of the low event rates, the analysis could not exclude modest differences in adverse events between atypical and typical APM s.