D. L. Davenport1, J. S. Roth1, N. Ward3, L. Mutiso4, C. C. Lester2, K. M. Lommel2, D. L. Davenport1 1University Of Kentucky,Dept. Of Surgery,Lexington, KY, USA 2University Of Kentucky,Dept. Of Psychiatry,Lexington, KY, USA 3University Of Kentucky,College Of Medicine,Lexington, KY, USA 4University Of Kentucky,College Of Nursing,Lexington, KY, USA
Introduction: The incidence of psychiatric illness is increasing in the United States as is treatment with psychotropic medication. The area of the country in which this study was conducted also has a known high incidence of prescription drug abuse. There have been several reports of the effects of depression and antidepressants on cardiac surgery outcomes, but chronic anxiety and anxiolytics have been understudied. This study aimed to determine the relationship, if any, between preoperative anxiolytic medication and morbidity after a broad range of non-cardiac surgeries.
Methods: A retrospective review of the American College of Surgeons National Surgery Quality Improvement Program data at a single large academic medical center was performed with the addition of anxiolytic prescription medication (AXM, benzodiazepines or hydroxyzine HCL) identified at admission from the patients’ active medication list. The data reflected a prospective, 100% sample of 20 major general, vascular, urologic and plastic surgical procedures performed at our hospital between October 1, 2011 and September 30, 2012. The data included demographics, >30 comorbid clinical risks, procedural variables and 21 specific complications and death for up to 30 days after major surgery. Major morbidity (MM) was defined as a patient having one or more of the complications or death.
Results: We reviewed a total of 1847 surgical patients of whom 289 (15.6%) were taking AXM at admission. AXM use varied significantly by type of procedure (p <.001) with breast reconstruction patients having >25% AXM use while appendectomy and prostatectomy <7% AXM use. Operative duration was ½ hour longer on average in AXM patients (p <.001) who were also more likely to be smokers, suffer from COPD, dyspnea and hypertension (all p <.001). They had higher MM (24.3% vs 14.9%, p <.001), particularly infections (16.3% vs. 9.4%, p =.001) and 1 day longer median hospital stay (3 vs 2 days, p <.001). In multivariable logistic regression, AXM was an independent predictor of MM (odds ratio 1.73, 95% CI 1.09-2.75, p=.021) after adjustment for the procedure performed, clinical and demographic risk factors. Conclusion: We found that 15.6% of our non-cardiac surgery patients were actively taking anxiolytics at admission and that these patients had significantly worse risk-adjusted short-term surgical outcomes, particularly infection. Future studies are needed to study mechanism; particularly whether the observed outcomes were caused by physiologic changes due to chronic anxiety or to the medications themselves.