Widaeus Matilda, Hertzberg Daniel, Hallqvist Linn, Bell Max
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
BJA Open. 2023 Jul 21;7:100218. doi: 10.1016/j.bjao.2023.100218. eCollection 2023 Sep.
Whilst somatic complications after major surgery are being increasingly investigated, the research field has scarce data on psychiatric outcomes such as postoperative depression. This study evaluates the impact of patient and surgical factors on the risk of depression after surgery using the proxy measure of prescribed and collected antidepressants.
An observational, registry-based, national multicentre cohort study of individuals ≥18 yr of age who underwent noncardiac surgery between 2007 and 2014. Exclusion criteria included history of antidepressant use defined by collection of a prescription within 5 yr before surgery. Participants were identified using a surgical database from 23 Swedish hospitals and data were linked to National Board of Health and Welfare registers for collection of prescribed antidepressants. Descriptive statistics were used for baseline data and logistic regression for predictive factors.
Of 223 617 patients, 4.9% had a new prescription of antidepressants collected 31-365 days after surgery. Antidepressant prescription was associated with increasing age, female sex, and more comorbidities. The incidence of antidepressant prescription was highest after neurosurgery, vascular, and thoracic surgery. Affective and anxiety disorders were risk factors. In the whole cohort and within the aforementioned surgical subtypes, acute and cancer surgery increased the risk of antidepressant prescription.
This study brings novel insights to the epidemiology of postoperative antidepressant treatment in antidepressant-naive patients. One in 20 postoperative patients are prescribed antidepressants but with knowledge of risk factors, interventional strategies can be tested.
虽然对大手术后的躯体并发症研究日益增多，但该研究领域关于术后抑郁等精神科结局的数据却很匮乏。本研究使用开具和领取抗抑郁药这一替代指标，评估患者因素和手术因素对术后抑郁风险的影响。
一项基于登记处的全国性多中心观察性队列研究，研究对象为2007年至2014年间接受非心脏手术的18岁及以上个体。排除标准包括术前5年内有抗抑郁药使用史（以开具处方为定义）。通过瑞典23家医院的手术数据库识别参与者，并将数据与瑞典国家卫生和福利委员会登记处相链接，以收集开具的抗抑郁药信息。描述性统计用于基线数据，逻辑回归用于分析预测因素。
在223617例患者中，4.9%在术后31 - 365天领取了新的抗抑郁药处方。抗抑郁药处方与年龄增加、女性以及更多合并症相关。神经外科、血管外科和胸外科手术后抗抑郁药处方发生率最高。情感障碍和焦虑症是危险因素。在整个队列以及上述手术亚型中，急症手术和癌症手术增加了抗抑郁药处方风险。
本研究为未服用过抗抑郁药患者术后抗抑郁治疗的流行病学提供了新见解。每20例术后患者中有1例会开具抗抑郁药，但了解危险因素后，可对干预策略进行测试。
