Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery Perioperative SSRI Use and Adverse Outcome Risk

Auerbach AD, Vittinghoff E, Maselli J, et al. — Mon, 29 Apr 2013 00:00:00 GMT

Importance

Single-site studies have described an association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes of surgery. Multicenter studies including a broad range of surgical procedures that explore rare outcomes, such as bleeding and mortality, and that account for indications for administration of SSRIs are needed.

Objective

To determine whether perioperative use of SSRIs is associated with adverse outcomes of surgery in a national sample of patients.

Design

Retrospective study of patients 18 years or older who underwent major surgery from January 1, 2006, through December 31, 2008, at 375 US hospitals. We used multivariable hierarchical models to estimate associations between SSRI use and our outcomes. Pharmacy data were used to determine whether a patient received an SSRI in the perioperative period.

Setting

Three hundred seventy-five US hospitals.

Participants

Five hundred thirty thousand four hundred sixteen patients 18 years or older.

Exposure

Perioperative use of SSRIs.

Main Outcomes and Measures

In-hospital mortality, length of stay, readmission at 30 days, bleeding events, transfusions, and incidence of ventricular arrhythmias.

Results

Patients receiving SSRIs were more likely to have obesity, chronic pulmonary disease, or hypothyroidism (P < .001 for each) and more likely to have depression (41.0% vs 6.2%, P < .001). After adjustment, patients receiving SSRIs had higher odds of in-hospital mortality (adjusted odds ratio, 1.20 [95% CI, 1.07-1.36]), bleeding (1.09 [1.04-1.15]), and readmission at 30 days (1.22 [1.18-1.26]). Similar results were observed in propensity-matched analyses, although the risk of inpatient mortality was attenuated among patients with depression. Sensitivity analyses suggest that, to invalidate our results, an unmeasured covariate would have to have higher prevalence and be more strongly associated with mortality than any covariate included in our models.

Conclusions and Relevance

Receiving SSRIs in the perioperative period is associated with a higher risk for adverse events. Determining whether patient factors or SSRIs themselves are responsible for elevated risks requires prospective study.

Selective Serotonin Reuptake Inhibitors and Surgery: To Hold or Not to Hold, That Is the Question Comment on “Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery” SSRIs and Surgery

Mrkobrada M, Hackam DG. — Mon, 29 Apr 2013 00:00:00 GMT

More than 200 million major surgical operations are undertaken worldwide every year. Surgery is particularly prevalent in the developed world, with an astounding 21 397 operations per 100 000 persons performed in the United States in 2004. Surgery also carries significant risks. A recent international prospective cohort study of 15 133 adult patients undergoing noncardiac surgery demonstrated a 30-day mortality rate of 1.9% (95% CI, 1.7%-2.1%). This finding, coupled with the high global prevalence of surgery, suggests that postoperative mortality and morbidity are a significant public health concern.

JAMA Internal Medicine: Psychopharmacology Topic Collection

Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery Perioperative SSRI Use and Adverse Outcome Risk

Selective Serotonin Reuptake Inhibitors and Surgery: To Hold or Not to Hold, That Is the Question Comment on “Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery” SSRIs and Surgery