International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Schoeneman Building, 2 Floor, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):3903-3908. doi: 10.1007/s00590-024-04069-4. Epub 2024 Aug 25.
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for psychiatric conditions. Previous studies have shown that SSRIs can increase bleeding risk by affecting platelet aggregation. However, their impact on perioperative outcomes in hip surgery remains uncertain. This case-control study examines the link between preoperative SSRI use and perioperative transfusion requirements in hip surgery patients.
Data from the M161Ortho dataset of Pearl Diver patient records database were utilized. Patients who underwent hip joint surgery between 2010 and 2022 and had documented preoperative SSRI use within one month prior to surgery were included. Patients with coagulopathy disorders or coagulopathy medication use were excluded. Perioperative transfusion need was defined as receiving red blood cell or whole blood transfusions on the same date or within 10 days following the surgery.
A total of 75,374 patients with preoperative SSRI use were matched with an equal number of non-SSRI users. Preoperative SSRI use was associated with an increased risk of requiring perioperative transfusion (5.7% vs. 5.1%, P < 0.001). Subgroup analysis demonstrated increased transfusion risk in patients undergoing pinning (2.6% vs. 1.8%, P = 0.02), open reduction with internal fixation (ORIF) (8.9% vs. 8.2%, P = 0.007), and total hip arthroplasty (THA) (3.8% vs. 3.4%, P < 0.001), but no significant difference was observed in patients undergoing hemiarthroplasty.
Clinicians should be aware of the potential risk of increased perioperative transfusion requirements in hip surgery patients using SSRIs, especially during pinning, ORIF, and THA procedures. It is essential to consider this when managing patients on SSRIs before hip surgery.
选择性 5-羟色胺再摄取抑制剂（SSRIs）常用于治疗精神疾病。先前的研究表明，SSRIs 通过影响血小板聚集来增加出血风险。然而，它们在髋关节手术中的围手术期结果的影响尚不确定。本病例对照研究旨在探讨术前使用 SSRIs 与髋关节手术患者围手术期输血需求之间的关系。
本研究使用 Pearl Diver 患者记录数据库的 M161Ortho 数据集。纳入 2010 年至 2022 年间接受髋关节手术且术前一个月内有记录的 SSRIs 使用史的患者。排除存在凝血功能障碍或正在使用抗凝药物的患者。围手术期输血需求定义为在手术当天或手术后 10 天内接受红细胞或全血输血。
共纳入 75374 例术前使用 SSRIs 的患者，与相同数量的未使用 SSRIs 的患者进行匹配。与未使用 SSRIs 的患者相比，术前使用 SSRIs 与围手术期输血需求增加相关（5.7% vs. 5.1%，P<0.001）。亚组分析显示，在接受钢针固定术（2.6% vs. 1.8%，P=0.02）、切开复位内固定术（ORIF）（8.9% vs. 8.2%，P=0.007）和全髋关节置换术（THA）（3.8% vs. 3.4%，P<0.001）的患者中，输血风险增加，但在接受半髋关节置换术的患者中未观察到显著差异。
临床医生应意识到使用 SSRIs 的髋关节手术患者围手术期输血需求增加的潜在风险，尤其是在钢针固定术、ORIF 和 THA 手术中。在髋关节手术前管理 SSRIs 患者时，应考虑到这一点。
