Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?
To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy.



Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual.



Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes.



Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group.



ISRCTN40219584.
Leeds and York Partnership NHS Foundation Trust, York, UK.
Barry
B
Wright
York Hospitals NHS Foundation Trust, York, UK.
David
0000-0002-7052-7655
D
Alexander
York Hospitals NHS Foundation Trust, York, UK.
Assad
A
Aghahoseini
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000523:psychology*; D003863:Depression / Q000150:complications* / Q000188:drug therapy / Q000235:genetics*; D005260:Female; D005820:Genetic Testing; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000523:psychology*; D057234:Preoperative Period; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D050486:Serotonin Plasma Membrane Transport Proteins / Q000235:genetics*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D000928:Antidepressive Agents; C493230:SLC6A4 protein, human; D050486:Serotonin Plasma Membrane Transport Proteins
GENETICS; MENTAL HEALTH