Selective serotonin reuptake inhibitor use and mortality, postoperative complications, and quality of care in hip fracture patients: a Danish nationwide cohort study

Abstract

PurposeTo examine the association between selective serotonin reuptake inhibitor (SSRI) use and mortality, postoperative complications, and quality of in-hospital care in hip fracture patients.Patients and methodsThe study was a nationwide cohort study based on individual-level linked, prospectively collected data from Danish population-based national registries covering all hospitals in Denmark. The health care system in Denmark is tax-funded, and all citizens have equal access to health care services. We included patients with first-time hospitalization due to hip fracture undergoing surgery from 2006–2016. We estimated the risk of 30-day mortality, any unplanned readmission, any reoperation, specific postoperative complications including cardiovascular events and major bleeding, and quality of in-hospital care using Cox and Poisson regression analyses comparing current and former SSRI users with non-users.ResultsIn 68,487 hip fracture patients, 13,272 (19%) were current SSRI users, 2,777 (4%) were former SSRI users, and 52,438 (77%) were SSRI non-users. The 30-day mortality risk was 13% in current SSRI users (HR 1.16, 1.10–1.21) and 12% in former (HR 1.15, 1.04–1.27) compared with 10% in non-users. The HR for any unplanned readmission was 1.11 (1.02–1.20) in current and 1.13 (1.01–1.27) in former SSRI users and for any reoperation 1.21 (1.11–1.31) in current and 1.04 (0.84–1.28) in former SSRI users compared with non-users. The risk of venous thromboembolism, myocardial infarction, stroke, and bleeding were similar irrespective of SSRI use. No association between current and former SSRI use and quality of in-hospital care was found.ConclusionIn patients undergoing hip fracture surgery, 30-day mortality and overall readmission risk were elevated in both current and former SSRI users compared with non-users. Those currently using SSRI had a 26% increased reoperation risk compared with non-users. However, SSRI use was not associated with increased risk of other postoperative complications and lower quality of in-hospital care. A limitation of this study was the inability to control for potential confounding of social deprivation.

Selective serotonin reuptake inhibitor use in hip fracture patients: a Danish nationwide prevalence study

“…Furthermore, patients redeeming 2 prescriptions are more likely to take their medication and a sensitivity analysis in a previous study showed no difference between hip fracture patients redeeming only 1 prescription and those redeeming 2 (Bruun et al. 2018). Second, comorbidity information was obtained from the Danish National Patient Registry, which holds only data on patients treated in the hospital sector.…”

Prevalence and Risk Factors of Postoperative Falls Following Foot and Ankle Surgery

“…14,19,21,24,38 The medications used to treat depression are not without risk, as antidepressant medications are a known risk factor for falls and adverse operative outcomes. 3,4,21 This is due to the wide variety of adverse effects associated with antidepressants including but not limited to sedation, orthostatic hypotension, and anticholinergic effects. 37,38 Importantly, antidepressant use is reported by almost 13% of people in the United States illuminating that antidepressant use may be one of the most commonly encountered risk factors for postoperative falls by orthopaedic surgeons.…”

<p>The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients</p>

“…[22][23][24] An association between fulfillment of the process performance measures and better survival and lower readmission rate has been found [25][26][27][28] as well as an association between orthogeriatric specialization or patient volume and outcome. [29][30][31] In addition, associations between transfusion practice and outcome, 32,33 association between surgery delay and post-operative complications, 34,35 associations between some commonly used medication preoperatively, including antidepressants, anticoagulants and anti-inflammatory drugs and post-operative complications [36][37][38][39][40] have been observed. Moreover, studies have found that about 15% of hip fracture patients develop an acute kidney injury within 5 days of surgery 41,42 and about 15% of patients sustain postoperative infections within 30 days of surgery, 43,44 complications which are strongly associated with 30 days mortality.…”