Selective serotonin reuptake inhibitors and complications following primary total shoulder arthroplasty

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed medications; however, they have been associated with increased bleeding risk. Total shoulder arthroplasty (TSA) literature remains lacking. The purpose of this study is to examine the effect of SSRI on postoperative hematologic and surgical complications following primary TSA.

The PearlDiver Mariner database was queried for patients undergoing primary TSA. SSRI cohort consisted of patients prescribed an SSRI within 365 days preoperatively. Propensity score matching was performed to yield the non-SSRI cohort. Chi-square analysis assessed complication rates, and multivariable logistic regression determined whether SSRI use independently predicted complications. Significance was defined as p < 0.05.

Following chi-square analysis, SSRI cohort demonstrated higher rates of transfusion at 90 days (1.10% vs. 0.90%, p = 0.01) and 1 year (1.66% vs 1.44%, p = 0.04) postoperatively. SSRI cohort had higher rates of revision TSA (3.57% vs. 3.17%, p = 0.003) and mechanical failure (1.70% vs. 1.50%, p = 0.034) at 5 years postoperatively. After multivariable regression, SSRI cohort was not independently predictive of any postoperative complications.

SSRI was not independently predicative of any postoperative hematological or surgical complications following primary TSA. Therefore, SSRI use in TSA appears to be safe to take preoperatively and does not increase complications.

Level III - Retrospective cohort study.