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Conclusion: Preoperative risk scores are unable to reliably predict morbidity events after HPB operations in this series, while few selected scores (NSQIP, POSSUM) may contribute to risk stratification. Targeted query of few simple clinical parameters would better inform potential early interventions strategies in patients at risk for postoperative morbidity.

8.62%-8.75%) (63 215 of 728 229) to 14.46% (95% CI, 14.38%-14.54%) (101 454 of 701 551) from 2011 to 2018, while the percentage of adults dispensed zolpidem decreased from 33.65% (95% CI, 33.54%-33.76%) (245 026 of 728 229) to 22.60% (95% CI, 22.50%-22.70%) (158 532 of 701 551). The adjusted annual change was 0.69% (95% CI, 0.68%-0.70%) for trazodone and −2.31% (95% CI, −2.33% to −2.29%) for zolpidem. Results for trazodone were also similar for dosages less than or equal to 50 mg/d (Figure 2).Discussion | Low-dose trazodone was dispensed with increased frequency during the period before to nearly 2 years after a US guideline in early 2017 4 suggested not using trazodone for insomnia, although these increases were modest. Dispensing of zolpidem was already decreasing before 2 FDA safety announcements in 2013 5 and a black box warning in 2019. 6 In 2018, zolpidem was still being dispensed more frequently than low-dose trazodone, but the gap between these drugs has narrowed since 2011, suggesting an increasing preference toward off-label use of trazodone for insomnia. Study limitations include that the MarketScan databases lacked explicitly documented treatment indications and captured only commercially insured individuals. More studies evaluating the efficacy and safety of trazodone for insomnia are warranted.

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