Effects of perioperative benzodiazepine administration on postoperative patient-reported outcomes: a systematic review and meta-analysis of randomised controlled trials
Bibliographic record
Abstract
Background Benzodiazepines are administered during the perioperative period because they are believed to improve the patient experience. We conducted a systematic review and meta-analysis evaluating the effect of perioperative benzodiazepines on postoperative patient-reported outcomes. Methods We included randomised controlled trials of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative pain, quality of recovery, patient satisfaction, and anxiety. We assessed risk of bias using a modified Cochrane tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results We screened 33 220 abstracts, 1156 full texts, and 123 RCTs, of which 93 were included in the quantitative synthesis. We identified moderate certainty evidence that benzodiazepines have no effect on patient-reported postoperative pain or quality of recovery and very low certainty evidence that benzodiazepines have no effect on patient satisfaction. We identified low certainty evidence that benzodiazepines result in higher levels of postoperative anxiety (22 trials, n =2165; mean difference, 2.18 points on the 20–80 State-Trait Anxiety Inventory Scale; 95% confidence interval, 1.05–3.30; I 2 =90%). Conclusions Benzodiazepine administration in the perioperative period probably has no effect on postoperative pain or quality of recovery and has an uncertain effect on patient satisfaction (very low certainty evidence). When compared with placebo or another agent, benzodiazepines might result in higher levels of postoperative anxiety. Definitive research is required to determine whether the balance of risks and benefits justifies using benzodiazepines during the perioperative period to improve patient-reported outcomes. Systematic review protocol PROSPERO (CRD42023440326).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.096 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.043 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".