June’s paper of the month in Colorectal Diseases discusses the risk of postoperative complications in patients using antidepressants, a topic of interest which is largely unstudied

Preadmission use of antidepressants and risk of complications and death after colorectal cancer surgery: a nationwide population-based cohort study. K. D. Lycke, C. F. Christiansen, J. L. Lund, L. H. Iversen and M. Nørgaard. Colorectal Disease 2019, 21: 651-662.

What is known on the subject?

The authors investigated whether there is excess of short and long-term mortality in patients with psychiatric disorders undergoing colorectal cancer surgery. There are possible explanations for this e.g. delayed cancer diagnosis, more somatic comorbidities, an adverse lifestyle, etc. that are confounding the effect of the antidepressants.

What this study adds

The authors used the Danish Colorectal Cancer group Database, Civil Registration system, the Danish National Health Service Prescription database and Danish Intensive Care Database to analyze a nationwide cohort of colorectal cancer patients who underwent surgery from 2005 – 2012. In determining the effect of antidepressant use, correction was made for multiple confounding factors e.g. Charlson Comorbidity Index, age, gender, BMI, emergent/elective etc. The study included a huge cohort of 27,374 surgical patients finding that almost 12% of patients used antidepressants in the prior year, of whom 9% were taking medication within the 90 days prior to surgery. In the 70-79 years-of-age group this figure was even one out of three.

Mortality rates were almost double for current antidepressant users (11.4% versus 6.2%). After adjustment there was still an increase in mortality of 20% reflecting higher ICU admission rate and postoperative morbidity. There were significantly more fascial dehiscences, cardiac and pulmonary complications.

In addition, to addressing its central hypothesis, this paper also provided important insights in to the real world data on anastomotic leak rates, reoperation rates and mortality.

Implications for colorectal practice

The mechanism of how antidepressants cause increased postoperative morbidity and mortality is not known. The observation is however interesting and warrants further research. These data underpin the necessity of avoidance of overuse of antidepressants in the older generation.

 Report by Willem Bemelman

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