Selective serotonin re-uptake inhibitors and risks of post-operative hematoma after elbow fracture surgery

Selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine re-uptake inhibitors (SNRIs) are commonly prescribed medications for depression, anxiety, and other comorbid psychiatric conditions. However, these medications can have off-target effects, such as lowering platelet serotonin levels and reducing the ability of platelets to aggregate, which may lead to higher rates of post-operative bleeding. The aim of this paper was to determine if SSRIs/SNRIs increase the risk of post-operative hematoma formation following traumatic elbow surgery.

Adult patients who underwent elbow fracture surgery between 2009 and 2022 were reviewed retrospectively utilizing a national administrative claims database. Exclusion criteria included patients who sustained a pathological fracture, open fracture, had an active infection, or hematologic disorder at the time of surgery. Patients were divided into those who were not prescribed SSRIs/SNRIs (control) and those prescribed SSRIs/SNRIs within 90 days pre-operatively (treatment). Patient cohorts were then propensity-score matched in a 1:3 ratio. Multivariable logistic regression was performed to assess 30- and 90-day outcomes.

Over 6,000 patients were included in the initial query. After propensity-score matching, 985 patients were included in the control group (no SSRI/SNRI) and 2,494 patients in the treatment (SSRI/SNRI) group. At 30 days post-operatively, patients in the treatment group had a significantly greater rate of Surgical Site Infection (SSI) (3.4% vs. 2.2%; P = .04). There was no significant difference in rates of 30-day hematomas between the 2 cohorts. At 90 days post-operatively, there was a statistically significant difference in complications for patients treated with SSRI/SNRIs, including a higher rate of SSI (5.4% vs. 3.3%; P = .01) and hematoma formation (1.2% vs. 0.6%; P = .04).

SSRIs and SNRIs are commonly prescribed to patients for a variety of psychiatric conditions. These medications often go unnoticed in the pre-operative surgical assessment; however, this retrospective study suggests an association between SSRI/SNRI use and higher odds of SSI and hematoma formation.