Association between Preoperative Use of Selective Serotonin Reuptake Inhibitor Treatments and Post-hepatectomy Liver Failure after Liver Surgery: a Nationwide Cohort Study on the French Health Data System (SNDS)

Monday, August 26, 2024

5:30 PM – 5:45 PM CEST

Location: Room XV

Co-Author(s)

CP

Cécile Payet

Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France ; Hospices Civils de Lyon, Service des Données de Santé, Lyon, France, France
XM

Xavier Muller

Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France, France

Presenting Author(s)

Marie Viprey, PharmD, PhD

Deputy head of the health data department of the Hospices Civils de Lyon
Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France ; Hospices Civils de Lyon, Health Data Department, Lyon, France, France

Slides

Co-Author(s)

Aurélie Moskal, PhD (she/her/hers)

Health Data Analyst
Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France, France
SP

Stéphanie POLAZZI

Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France ; Hospices Civils de Lyon, Service des Données de Santé, Lyon, France, France
BC

Bruno CHARPIAT

Pharmacy Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France, France
JM

Jean-Yves MABRUT

Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France, France
AD

Antoine DUCLOS

Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France ; Hospices Civils de Lyon, Service des Données de Santé, Lyon, France, France
ML

Mickaël LESURTEL

Department of HPB surgery and liver transplantation, AP-HP, Beaujon Hospital, DMU DIGEST, University of Paris Cité, Paris, France., France

Background: Platelet‐stored serotonin critically affects liver regeneration. Selective serotonin reuptake inhibitors (SSRIs) reduce intraplatelet serotonin, which may inhibit liver regeneration. A small-sample study has shown an increased risk of post-hepatectomy liver failure (PHLF) in patients exposed to SSRIs in the months prior to surgery.

Objectives: To assess on a large scale whether SSRI treatment prior to liver surgery was associated with a risk of PHLF.

Methods: A population-based retrospective cohort study was conducted between 2013 and 2020 from the French National Health Data System (SNDS) among adults who underwent liver surgery. Patients exposed to an SSRI in the 30 days before surgery (SSRI+) were matched to unexposed patients (SSRI-) by propensity score. We considered patient characteristics (age, sex, French Deprivation Index, comorbidities, exposure to treatments associated with a risk of post-operative complications), surgery (type of hepatectomy, portal embolization, procedural codes associated to liver surgery) and hospital (volume of surgery, type of hospital)). The 30-day PHLF rate was compared between the two groups using logistic regression, and 90-day postoperative mortality was compared using a survival model. A sensitivity analysis was conducted on major hepatectomy subgroup.

Results: A total of 38,682 patients underwent liver surgery in 715 hospitals and 2467 (6.5%) patients were exposed to an SSRI. The rate of PHLF was comparable in the two groups (SSRI-:3.08% vs. SSRI+:2.96%). There was no association between SSRI use and PHLF (OR 0.96 95% CI (0.69-1.33), p=0.801) and between SSRI use and postoperative mortality at 90 days (HR 0.99 (0.75-1.32), p=0.946). Although the rate of PHLF was higher in major hepatectomy subgroup (SSRI- :10.15% vs. SSRI+ :8.08%), there was also no association between SSRI use and PHLF (OR 0.94 IC95% (0.74-1.21), p=0.652).

Conclusions: The use of SSRI prior to liver surgery was not associated with PHLF. These results are therefore not in favor of discontinuing an SSRI before surgery.