Key result
Current SSRI use in patients undergoing hip fracture surgery was associated with an increased risk of 30-day mortality compared with non-users (13% vs 10%; HR 1.16, 95% CI 1.10-1.21).
Why the study?
Does SSRI use increase mortality and postoperative complications in patients undergoing hip fracture surgery?
Cohort (n=68,487)
Yes
Does SSRI use increase mortality and postoperative complications in patients undergoing hip fracture surgery?
In patients undergoing hip fracture surgery, current and former SSRI use is associated with an increased risk of 30-day mortality and unplanned readmissions compared to non-users.
SSRI use signals higher 30-day mortality after hip fracture surgery; leaves open confounding versus causality for prospective trials.
PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Bruun et al. (2018) conducted a cohort in hip fracture (n=68,487). Selective serotonin reuptake inhibitor (SSRI) use vs. SSRI non-users was evaluated on 30-day mortality (HR 1.16, 95% CI 1.10-1.21). Current SSRI use in patients undergoing hip fracture surgery was associated with an increased risk of 30-day mortality compared with non-users (13% vs 10%; HR 1.16, 95% CI 1.10-1.21).
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