Selective serotonin reuptake inhibitor use and mortality, postoperative complications, and quality of care in hip fracture patients: a Danish nationwide cohort study.
Selective serotonin reuptake inhibitor use and mortality, postoperative complications, and quality of care in hip fracture patients: a Danish nationwide cohort study.
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DOI：
10.2147/clep.s166309
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发表时间：
2018
影响因子：
3.9
通讯作者：
Pedersen AB
中科院分区：
文献类型：
--
作者：
Bruun SB;Petersen I;Kristensen NR;Cronin-Fenton D;Pedersen AB
探讨选择性血清素再摄取抑制剂（SSRI）的使用与髋部骨折患者死亡率、术后并发症和住院护理质量之间的关系。该研究是一项全国性队列研究，基于个人水平的关联，前瞻性收集来自丹麦人口为基础的国家登记处的数据，涵盖丹麦所有医院。丹麦的医疗保健系统由税收资助，所有公民都有平等的机会获得医疗保健服务。我们纳入了2006-2016年因髋部骨折首次住院接受手术的患者。我们使用Cox和泊松回归分析对当前和以前SSRI使用者与非SSRI使用者进行比较，估计了30天死亡率、任何意外再入院、任何再手术、特定的术后并发症（包括心血管事件和大出血）以及院内护理质量的风险。68,487例髋部骨折患者中，13,272例（19%）为当前SSRI使用者，2,777例（4%）为既往SSRI使用者，52,438例（77%）为非SSRI使用者。当前SSRI使用者的30天死亡风险为13% (HR 1.16, 1.10-1.21)，先前SSRI使用者的30天死亡风险为12% (HR 1.15, 1.04-1.27)，非SSRI使用者的30天死亡风险为10%。与非SSRI使用者相比，任何计划外再入院的HR在当前SSRI使用者中为1.11(1.02-1.20)，在以前SSRI使用者中为1.13(1.01-1.27)，任何再次手术的HR在当前SSRI使用者中为1.21(1.11 - 1.31)，在以前SSRI使用者中为1.04（0.84-1.28）。静脉血栓栓塞、心肌梗死、中风和出血的风险与SSRI的使用无关。目前和以前的SSRI使用与院内护理质量之间没有关联。在接受髋部骨折手术的患者中，与未使用SSRI的患者相比，目前和以前使用SSRI的患者的30天死亡率和总体再入院风险均升高。与未使用SSRI的患者相比，目前使用SSRI的患者再手术风险增加26%。然而，SSRI的使用与其他术后并发症的风险增加和院内护理质量降低无关。本研究的一个局限性是无法控制社会剥夺的潜在混淆。
To examine the association between selective serotonin reuptake inhibitor (SSRI) use and mortality, postoperative complications, and quality of in-hospital care in hip fracture patients. The 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. In 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. In 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.