title: Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Three hundred seventy-five US hospitals.
  
  
  METHODS
  Five hundred thirty thousand four hundred sixteen patients 18 years or older.
  
  
  METHODS
  Perioperative use of SSRIs.
  
  
  METHODS
  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
  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.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, PO Box 0131, San Francisco, CA 94143, USA. ada@medicine.ucsf.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Judith
authors.initials: J
authors.lastname: Maselli
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.forename: John Q
authors.initials: JQ
authors.lastname: Young
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors