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Associations between anxiolytic medications and ventral hernia repair

  • C. Neff
  • C. Totten
  • M. Plymale
  • D. R. Oyler
  • D. Davenport
  • J. S. Roth
Original Article



This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair.


A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program.


Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions.


Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.


Ventral hernia Anxiolytics NSQIP Hospital readmissions Perioperative risk factors 




Compliance with ethical standards

Conflict of interest

Drs. Neff, Totten, Plymale, Oyler, and Davenport declare no conflicts of interest. Dr. Roth declares conflict of interest not directly related to the submitted work: grants, personal fees, and other from Bard; grants, personal fees, and other from Acelity; grants from Miromatrix, and grants from MTF.

Ethical approval

The University of Kentucky Medical Institutional Review Board reviewed and approved this study.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this study, formal consent was not required.


  1. 1.
    Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA (2014) The global burden of anxiety disorders in 2010. Psychol Med 44:2363–2374CrossRefPubMedGoogle Scholar
  2. 2.
    Baxter AJ, Scott KM, Vos T, Whiteford HA (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43:897–910CrossRefPubMedGoogle Scholar
  3. 3.
    Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Ustün TB, Wang PS (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc 18:23–33CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602CrossRefPubMedGoogle Scholar
  6. 6.
    Mendlowicz MV, Stein MB (2000) Quality of life in individuals with anxiety disorders. Am J Psychiatry 157:669–682CrossRefPubMedGoogle Scholar
  7. 7.
    Tully PJ, Baker RA, Turnbull D, Winefield H (2008) The role of depression and anxiety symptoms in hospital readmissions after cardiac surgery. J Behav Med 31:281–290CrossRefPubMedGoogle Scholar
  8. 8.
    Tully PJ, Baker RA, Knight JL (2008) Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. J Psychosom Res 64:285–290CrossRefPubMedGoogle Scholar
  9. 9.
    Williams JB, Alexander KP, Morin JF et al (2013) Preoperative anxiety as a predictor of mortality and major morbidity in patients aged > 70 years undergoing cardiac surgery. Am J Cardiol 111:137–142CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ward N, Roth JS, Lester CC, Mutiso L, Lommel KM, Davenport DL (2015) Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery. Surgery 158:420–427CrossRefPubMedGoogle Scholar
  11. 11.
    Grohol JM (2017) The top psychiatric medications for 2013. Psych Central. Accessed 1 June 2017
  12. 12.
    Bourdon KH, Rae DS, Locke BZ, Narrow WE, Regier DA (1992) Estimating the prevalence of mental disorders in US adults from the Epidemiologic Catchment Area Survey. Public Health Rep 107:663–668PubMedPubMedCentralGoogle Scholar
  13. 13.
    Pignay-Demaria V, Lesperance F, Demaria RG, Frasure-Smith N, Perrault LP (2003) Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg 75:314–321CrossRefPubMedGoogle Scholar
  14. 14.
    Gariepy G, Nitka D, Schmitz N (2010) The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes (Lond) 34:407–419CrossRefGoogle Scholar
  15. 15.
    Willgoss TG, Yohannes AM (2013) Anxiety disorders in patients with COPD: a systematic review. Respir Care 58:858–866PubMedGoogle Scholar
  16. 16.
    Goodwin RD (2003) Association between physical activity and mental disorders among adults in the United States. Prev Med 36:698–703CrossRefPubMedGoogle Scholar
  17. 17.
    Johnson JG, Cohen P, Pine DS, Klein DF, Kasen S, Brook JS (2000) Association between cigarette smoking and anxiety disorders during adolescence and early adulthood. JAMA 284:2348–2351CrossRefPubMedGoogle Scholar
  18. 18.
    Babcock GF, Hernandez L, Yadav E, Schwemberger S, Dugan A (2012) The burn wound inflammatory response is influenced by midazolam. Inflammation 35:259–270CrossRefPubMedGoogle Scholar
  19. 19.
    Zavala F, Taupin V, Descamps-Latscha B (1990) In vivo treatment with benzodiazepines inhibits murine phagocyte oxidative metabolism and production of interleukin 1, tumor necrosis factor and interleukin-6. J Pharmacol Exp Ther 255:442–450PubMedGoogle Scholar
  20. 20.
    Ma JF, Qiao Y, Gao X, Liang L, Liu XL, Li DH, Tang HD, Chen SD (2017) A community based study of risk factors for probably rapid eye movement sleep behavior disorder. Sleep Med 30:71–76CrossRefPubMedGoogle Scholar
  21. 21.
    Nguyen TQ, Liang CL, Marks GA (2013) GABA(A) receptors implicated in REM sleep control express a benzodiazepine binding site. Brain Res 1527:131–140CrossRefPubMedGoogle Scholar
  22. 22.
    Egydio F, Tomimori J, Tufik S, Andersen ML (2011) Does sleep deprivation and morphine influence wound healing? Med Hypotheses 77:353–355CrossRefPubMedGoogle Scholar
  23. 23.
    Egydio F, Pires GN, Tufik S, Andersen ML (2012) Wound healing and benzodiazepines: does sleep play a role in this relationship? Clinics (Sao Paulo) 67:827–830CrossRefGoogle Scholar
  24. 24.
    Saravay SM, Steinberg MD, Weinschel B, Pollack S, Alovis N (1991) Psychological comorbidity and length of stay in the general hospital. Am J Psychiatry 148:324–329CrossRefPubMedGoogle Scholar
  25. 25.
    Volz A, Schmid JP, Zwahlen M, Kohls S, Saner H, Barth J (2011) Predictors of readmission and health related quality of life in patients with chronic heart failure: a comparison of different psychosocial aspects. J Behav Med 34:13–22CrossRefPubMedGoogle Scholar
  26. 26.
    Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R (1995) Slowing of wound healing by psychological stress. Lancet 346:1194–1196CrossRefPubMedGoogle Scholar
  27. 27.
    Kain ZN, Sevarino F, Alexander GM, Pincus S, Mayes LC (2000) Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design. J Psychosom Res 49:417–422CrossRefPubMedGoogle Scholar
  28. 28.
    Tsigos C, Chrousos GP (2002) Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 53:865–871CrossRefPubMedGoogle Scholar
  29. 29.
    Ebrecht M, Hextall J, Kirtley LG, Taylor A, Dyson M, Weinman J (2004) Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Psychoneuroendocrinology 29:798–809CrossRefPubMedGoogle Scholar
  30. 30.
    Ader R, Cohen N, Felten D (1995) Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet 345:99–103CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General SurgeryUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.Department of SurgeryUniversity of Kentucky College of MedicineLexingtonUSA
  3. 3.Department of PharmacyUniversity of Kentucky HealthCareLexingtonUSA

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