Psychopharmacological treatment in patients planned for hip or knee replacement

• Published in: Basic & clinical pharmacology & toxicology 2024-07, Vol.135 (1), p.52-59
• Main Authors: Kornvig, Simon, Kehlet, Henrik, Jørgensen, Christoffer Calov, Fink‐Jensen, Anders, Videbech, Poul, Lindberg‐Larsen, Martin, Gromov, Kirill, Rasmussen, Mathias Bæk, Bieder, Manuel Josef, Varnum, Claus
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antidepressants; Antidepressive Agents - administration & dosage; Antidepressive Agents - therapeutic use; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Denmark; Depression - drug therapy; discontinuation; Feasibility; Female; Health services; Hip; Humans; Indication; Inhibitors; Knee; Length of Stay - statistics & numerical data; Male; Mental disorders; Mental Disorders - drug therapy; Middle Aged; Norepinephrine; Orthopaedic implants; Orthopedics; Patients; Psychopharmacology; replacement; Risk factors; Selective Serotonin Reuptake Inhibitors - administration & dosage; Selective Serotonin Reuptake Inhibitors - therapeutic use; Serotonin; Serotonin and Noradrenaline Reuptake Inhibitors - administration & dosage; Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use; Serotonin uptake inhibitors
• ISSN: 1742-7835; 1742-7843
• DOI: 10.1111/bcpt.14017

Psychopharmacological treatment may be an independent risk factor for increased length of stay and readmission after hip and knee replacement. Thus, temporary perioperative discontinuation may be beneficial. However, little is known regarding the treatments, and not all are feasible to discontinue. Therefore, the aim of this study was to describe the treatments in terms of type, dose, duration, indication and initiating physician to assess the feasibility of temporary perioperative discontinuation. We included 482 patients planned for hip or knee replacement in psychopharmacological treatment for psychiatric disorders from 2021 to 2023 at five orthopaedic departments in Denmark. Most patients were treated with antidepressants (89%); most frequently, either selective serotonin reuptake inhibitors (SSRIs; 48%) or serotonin‐norepinephrine reuptake inhibitors (SNRIs; 21%). The majority received monotherapy (70%); most frequently, an SSRI (36%) or an SNRI (12%). Most antidepressants were initiated by general practitioners (71%), and the treatments had lasted for more than a year (87%). The doses of SSRIs/SNRIs were moderate, and the most frequent indication for antidepressants was depression (77%). These results imply that temporary perioperative SSRI/SNRI discontinuation may be feasible in hip and knee replacement patients and support a future randomized controlled trial investigating the potential benefits of temporary discontinuation.