title: Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery.
abstract: BACKGROUND
  This study examined the effects of the use of anxiolytic medications (AXM) and antidepressant medications (ADMs) on outcomes after noncardiac surgery.
  
  
  METHODS
  A single-center review of prospectively obtained, perioperative and 30-day outcome data, including AXM and ADM use at admission, as part of the National Surgery Quality Improvement Program.
  
  
  RESULTS
  Of the 1846 patients undergoing surgery, 380 (20.6%) were taking an ADM, 288 (15.6%) AXM, 124 (6.7%) were taking both, and 545 (29.5%) were taking either at the time of admission. Both ADM and AXM patients more often were female than nonusers, had a greater American Society of Anesthesiologists class and suffered more from hypertension, COPD, and dyspnea (all P < .005). AXM patients also were more often smokers. ADM patients had a greater mortality and a greater risk of an infective complication, but these effects did not remain after adjustment for procedure and comorbid risks. Patients taking AXM had greater duration of stay, as well as an increased incidence of return to the operating room, infections, wound occurrences, and cardiovascular or cerebrovascular events (all P < .005). After adjustment, AXM was associated with greater combined major morbidity or mortality (odds ratio 1.72, 95% confidence interval 1.08-2.73, P = .023).
  
  
  CONCLUSIONS
  AXM was used by 16% of patients in our institution undergoing a noncardiac operation and was an independent risk factor for poorer short-term outcome after surgery. ADM was found to be used by 21% of patients but was not an independent risk factor for poor outcome.
authors.affiliation: College of Medicine, University of Kentucky, Lexington, KY.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ward
authors.affiliation: Department of Surgery, University of Kentucky, Lexington, KY.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Roth
authors.affiliation: Department of Psychiatry, University of Kentucky, Lexington, KY.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Lester
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY.
authors.forename: Lori
authors.initials: L
authors.lastname: Mutiso
authors.affiliation: Department of Psychiatry, University of Kentucky, Lexington, KY.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lommel
authors.affiliation: Department of Surgery, University of Kentucky, Lexington, KY. Electronic address: Daniel.Davenport@uky.edu.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications* / Q000188:drug therapy; D003863:Depression / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D057234:Preoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents