Israel Medical Association Journal

Serotonin (5-hydroxytryptamin, 5-HT) is a vital monoamine neurotransmitter that modulates various physiological processes. Selective serotonin reuptake inhibitors (SSRIs) are commonly used for the management of depressive disorders. Prolonged administration of SSRIs may lead to reduced platelet aggregability due to the depletion of serotonin stores within platelets. However, the association between chronic SSRI use and the risk of postoperative bleeding remains a topic of debate, with no standardized guidelines for managing this risk in the field of plastic surgery. This literature review and case report highlights the importance of considering chronic SSRI use as a potential risk factor for postoperative bleeding in plastic surgery patients. Standardized guidelines for handling postoperative bleeding risk in patients using SSRIs are crucial for ensuring optimal surgical outcomes and patient safety.

Background: Statins and selective serotonin reuptake inhibitors (SSRIs) have beneficial effects on health outcomes in the general population. Their effect on survival in debilitated nursing home residents is unknown.

Objectives: To assess the relationships between statins, SSRIs, and survival of nursing home residents.

Methods: Baseline patient characteristics, including chronic medications, were recorded. The association of 5-year survival with different variables was analyzed. A sub-group analysis of survival was performed according to baseline treatment with statins and/or SSRIs.

Results: The study comprised 993 residents from 6 nursing homes. Of them, 285 were males (29%), 750 (75%) were fully dependent, and 243 (25%) were mobile demented. Mean age was 85 ± 7.6 years (range 65–108). After 5 years follow-up, the mortality rate was 81%. Analysis by sub-groups showed longer survival among older adults treated with only statins (hazard ratio [HR] for death 0.68, 95% confidence intervals [95%CI] 0.49–0.94) or only SSRIs (HR 0.6, 95%CI 0.45–0.81), with the longest survival among those taking both statins and SSRIs (HR 0.41, 95%CI 0.25–0.67) and shortest among residents not taking statins or SSRIs (P < 0.001). The survival benefit remained significant after adjusting for age and after conducting a multivariate analysis adjusted for sex, functional status, body mass index, mini-mental state examination, feeding status, arrhythmia, diabetes mellitus, chronic kidney disease, and hemato-oncological diagnosis.

Conclusion: Treatment with statins and/or SSRIs at baseline was associated with longer survival in debilitated nursing home residents and should not be deprived from these patients, if medically indicated.