This retrospective cohort study evaluated whether perioperative antidepressant (ADP) use is associated with differential postoperative outcomes following surgical resection of cutaneous melanoma. The investigation used the TriNetX federated electronic health record database to compare 90-day postoperative events between adult melanoma patients who did and did not have perioperative ADP exposure.
The authors conducted a propensity-matched retrospective analysis using the TriNetX network. The primary comparison examined 90-day postoperative complications and healthcare utilization after melanoma resection among adults with perioperative ADP use versus those without ADP use. The dataset and analytic approach were observational and retrospective.
After propensity matching, the analytic sample comprised 19,470 patients, with 9,735 patients in the ADP-exposed group and 9,735 in the non-exposed control group. The matching procedure was intended to balance baseline covariates between groups; specific baseline variables used for matching and detailed demographic or tumor-stage characteristics were not reported in the abstract.
Compared with matched controls, patients with perioperative ADP use had higher rates of multiple adverse postoperative outcomes within 90 days:
Wound disruption did not differ significantly between groups. One procedural difference observed was that patients in the control cohort were more likely to undergo lymph node biopsy than ADP users (1.3% vs 0.9%; P = 0.006).
The authors state that perioperative ADP use was associated with increased postoperative morbidity and greater healthcare utilization in the 90-day postoperative period. Importantly, the dataset lacked information on tumor characteristics and procedural complexity, which the investigators identified as key limitations. Because those surgical and tumor-specific factors could not be evaluated, the authors caution that the observed associations are best interpreted as ADP use acting as a marker of a higher-risk perioperative phenotype rather than definitive evidence of a direct causal effect of antidepressant medications on postoperative complications.
The study was published online ahead of print with DOI 10.1097/CMR.0000000000001144 and appears in Melanoma Research. The abstract presents aggregated outcome rates and statistical significance for reported comparisons; detailed methods, matching covariates, and adjusted effect estimates were not provided in the abstract.
Based on the observed associations, the authors recommend proactive strategies for the perioperative management of melanoma patients on antidepressants. Recommended approaches in the abstract include:
Given the dataset limitations, clinicians should interpret these findings as signal-generating rather than definitive proof of causality. The results support heightened perioperative surveillance for patients receiving antidepressant therapy and consideration of tailored perioperative planning to mitigate identified risks.
In a large propensity-matched cohort drawn from TriNetX, perioperative antidepressant use in adults undergoing cutaneous melanoma resection was associated with higher 90-day rates of opioid prescriptions, surgical site infection, sepsis, inpatient hospitalization, emergency department visits, and hemorrhage. Absence of tumor and procedural detail in the dataset limits causal inference; ADP use may mark a higher-risk patient phenotype. The authors advocate proactive monitoring, infection surveillance, and careful opioid stewardship for this population.