Preadmission use of antidepressants and risk of complications and death after colorectal cancer surgery: a nationwide population‐based cohort study

Abstract

Aim Few studies have evaluated how preadmission use of antidepressants affects outcomes in colorectal cancer (CRC) patients after they have undergone surgery. Therefore, our aim is to examine whether preadmission use of antidepressants increased the risk of complications and death in patients who underwent CRC surgery. Method Using the Danish Colorectal Cancer Group Database we identified patients who underwent CRC surgery in Denmark from 2005 to 2012. We identified prescriptions for antidepressants redeemed within 1 year prior to surgery and categorized patients as current users (≤ 90 days), former users (91–365 days) and nonusers. All patients were followed from surgery to 30 days thereafter or to death. We calculated 30‐day rates of complications, intensive care unit (ICU) admission and mortality and compared these between users and nonusers using logistic and Cox regression adjusting for potential confounders. Results Of 27 374 patients, 8.9% were current users and 3.0% were former users. Antidepressant users were older and had more comorbidity but a similar cancer stage. Compared with nonusers, current users had a higher risk of postoperative reoperation [adjusted odds ratio (aORs) = 1.15 (95% CI 1.02–1.30)], medical complications [aORs = 1.41 (95% CI 1.25–1.60)] and increased ICU admission rate [adjusted hazard ratio (aHR) = 1.32 (95% CI 1.21–1.45)]. The 30‐day mortality was 11.4% for current users, 9.1% for former users and 6.2% for nonusers [aHR = 1.34 (95% CI 1.17–1.53) for current vs nonusers]. Conclusion Patients with preadmission use of antidepressants had a higher risk of complications and ICU admission, and higher 30‐day mortality following CRC surgery than nonusers.

The Fibrinolytic System in Peripartum Depression

“…In this retrospective study conducted in a Brazilian maternity hospital, 5% of 118 non-anticoagulated women on serotonergic antidepressants had wound hematoma, seroma, or dehiscence, compared with 0.2% of 1,611 women without anticoagulants and antidepressants. An increased risk of surgical wound dehiscence has been previously described in users of serotonergic antidepressants, 58 59 suggesting that these medications may induce the degradation of the fibrin mesh that forms the scar tissue.…”