Mortality and morbidity following postoperative use of short‐term, low‐dose quetiapine vs risperidone in patients with diabetes: Analysis using a national inpatient database. Issue 12 (12th November 2020)

• Record Type: Journal Article
• Authors: Sato, Daisuke; Uda, Kazuaki; Kumazawa, Ryosuke; Matsui, Hiroki; Yasunaga, Hideo
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 29:Issue 12(2020)
• Page Start: 1703
• Page End: 1709
• Publication Date: 2020-11-12
• Subjects: hyperglycemia -- pharmacoepidemiology -- propensity score -- quetiapine -- retrospective study; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.5164
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: Short‐term, low‐dose quetiapine is used to treat postoperative delirium and insomnia. Quetiapine is contraindicated for patients with diabetes in Japan because there have been several case reports of diabetic ketoacidosis (DKA) in patients receiving long‐term, high‐dose quetiapine. However, because safety of short‐term, low‐dose quetiapine remains controversial, it is prescribed for patients with diabetes in real‐world clinical practice. The present study aimed to compare in‐hospital mortality and morbidity between short‐term, low‐dose quetiapine and risperidone in postoperative patients with diabetes. Methods: We used a national inpatient database in Japan to perform a retrospective cohort study. We identified hospitalized patients with diabetes who underwent scheduled elective surgery and received oral quetiapine 200 mg/d or less or oral risperidone 4 mg/d or less within 7 days of surgery between July 2010 and March 2018. We performed one‐to‐one propensity score‐matched analyses to compare outcomes between patients with quetiapine and risperidone. The primary outcome was in‐hospital mortality. The secondary outcome was infectious complications (pneumonia, urinary tract infection, surgical site infection, and sepsis). Results: Propensity score matching created 665 pairs of patients who received quetiapine or risperidone. The primary outcome was observed in 19 (2.9%) of the quetiapine group and 11 (1.7%) of the risperidone group (relative risk, 1.27; 95% confidence interval, 0.97–1.68; P = .14). The secondary outcome did not differ significantly between the groups. Conclusion: In terms of mortality and infectious outcomes, safety of quetiapine and risperidone may be comparable.