Oral antipsychotics show similar safety profile in older adults after major surgery

Comparisons of atypical antipsychotics and haloperidol reveal similar rates of in-hospital adverse clinical events in older patients with postoperative delirium who have taken an oral low-to-moderate dose antipsychotic drug, a study has shown.

A team of investigators conducted this retrospective cohort study in US hospitals and included 17,115 patients (aged ≥65 years) without psychiatric disorders who were prescribed an oral antipsychotic drug following a major surgery from 2009 to 2018. These medications included haloperidol (≤4 mg on the day of initiation), olanzapine (≤10 mg), quetiapine (≤150 mg), and risperidone (≤4 mg).

The investigators estimated the risk ratios (RRs) for in-hospital death, cardiac arrhythmia events, pneumonia, and stroke or transient ischaemic attack (TIA) after propensity score overlap weighting.

Of the patients (mean age 79.6 percent), 60.5 percent were female, and 3.1 percent had in-hospital death. Quetiapine was the most prescribed antipsychotic drug (53.0 percent of total exposure).

No statistically significant difference was observed in the risk for in-hospital mortality among patients treated with haloperidol (3.7 percent, reference group), olanzapine (2.8 percent; RR, 0.74, 95 percent confidence interval [CI], 0.42‒1.27), quetiapine (2.6 percent; RR, 0.70, 95 percent CI, 0.47‒1.04), and risperidone (3.3 percent; RR, 0.90, 95 percent CI, 0.53‒1.41).

There were also no statistically significant between-group differences seen in the risk for nonfatal clinical events, which ranged from 2.0‒2.6 percent for a cardiac arrhythmia event, 4.2‒4.6 percent for pneumonia, and 0.6‒1.2 percent for stroke or TIA.

Of note, the study was limited by residual confounding by delirium severity, the lack of an untreated group, and restriction to oral low-to-moderate dose treatment.