Perioperative medicine & outcomes
Brain-Hazardous Medications and Potential Subadequate Antidepressant Dosing in Older Surgical Patients Receiving Home Antidepressants: An Observational Study of a Large US Health System
Authors' conclusion
Older surgical patients receiving antidepressants are frequently prescribed brain-hazardous medications and potentially subadequate antidepressant doses. Those receiving subadequate antidepressant doses may be at risk for worse postoperative outcomes compared to patients receiving adequate doses.
Study context
- Population
- Patients ≥60 years undergoing inpatient surgery with overnight stay, US academic health system, 2021; analysis of those on home antidepressants2,087 on antidepressants
- Participants
- 8,031 patients
- Exposure
- Home central nervous system (CNS)-active potentially inappropriate medication (PIM) vs none; potential subadequate vs adequate antidepressant dosing
- Outcome
- Prevalence of home CNS-active PIM and potential subadequate antidepressant dosing in older surgical patients receiving home antidepressants
Methodological detailsobservational, integrated academic health care system (14 hospitals)
- Observational
- Integrated academic health care system (14 hospitals)
Main finding
As reported in the abstract
Receiving ≥1 CNS-active PIM
49%
95% CI 46.5–50.1
Receiving a potential subadequate dose
29%
95% CI 27.0–29.3
Observational data: associations, not effects.
Further findings
| Outcome | Subadequate dose | Adequate dose | P value |
|---|---|---|---|
| Discharged homeSubadequate dose vs Adequate dose | 64% | 73% | <0.01 |
| Hospital LOSSubadequate dose vs Adequate dose | 9 days | 7 days | <0.01 |
| MortalitySubadequate dose vs Adequate dose | 18% | 10% | <0.01 |
Factors associated with home CNS-active PIM
- Female sex, aOR
- 1.46
- Anxiety, aOR
- 2.43
- Asthma or COPD, aOR
- 1.39
- Serotonin-norepinephrine reuptake inhibitor use, aOR
- 1.54
Factors associated with potential subadequate antidepressant dose
- Age ≥75 years, aOR
- 1.57
- Black race, aOR
- 1.48
- Congestive HF, aOR
- 1.33
Discharge home, LOS and mortality: CNS-active PIM vs none
- No differences with or without CNS-active PIMs
Original publication
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