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. 2016 Sep 6;6(9):e007969.
doi: 10.1136/bmjopen-2015-007969.

Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?

Barry Wright  1 , David Alexander  2 , Assad Aghahoseini  2 ; York Surgical Outcomes Research Team
Collaborators, Affiliations

Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?

Barry Wright et al. BMJ Open. .

Abstract

Objective: To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy.

Design: Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual.

Results: Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes.

Conclusions: Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group.

Trial registration number: ISRCTN40219584.

Keywords: GENETICS; MENTAL HEALTH.

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Figures

Figure 1
Figure 1
Flow of patients through the study. ERCP, Endoscopic retrograde Cholangio pancreatography.
Figure 2
Figure 2
Percentage of preoperative abnormal questionnaire scores by serotonin transporter gene polymorphism. BDI, Beck Depression Inventory; EPQ-R, Eysenck Personality Questionnaire; HADS, Hospital Anxiety and Depression Scale.
Figure 3
Figure 3
Preoperative SF-36 subscale scores by serotonin transporter gene polymorphism. SF-36, 36-item Short Form Health Survey.
Figure 4
Figure 4
Percentage of postoperative abnormal questionnaire scores by serotonin transporter gene polymorphism. BDI, Beck Depression Inventory; EPQ-R, Eysenck Personality Questionnaire; HADS, Hospital Anxiety and Depression Scale.
Figure 5
Figure 5
Postoperative SF-36 subscale scores by serotonin transporter gene polymorphism. SF-36, 36-item Short Form Health Survey.
Figure 6
Figure 6
Postoperative pain and recovery scores by serotonin transporter gene polymorphism.
See this image and copyright information in PMC

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