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Preoperative Selective Serotonin Reuptake Inhibitor Use is Associated With Increased Complication Risk After Total
Samuel P Alfonsi1, Christine L Zickler1, Aditya S Yadav1
1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Introduction:
Preoperative selective serotonin reuptake inhibitor (SSRI) use has been associated with adverse outcomes following primary total hip arthroplasty (THA). This study examined whether complication rates vary based on SSRI daily dosage.
Methods:
A claims database (2010 to 2023) identified 77,958 primary THA patients who did not have osteoporosis and who filled an SSRI prescription 60 days preoperatively. Patients were matched 1:3 to SSRI-naive individuals by age, sex, Charlson Comorbidity Index, and history of cognitive disorders, depression, anxiety, and substance use. Overall, 77,958 SSRI users were matched to 233,277 controls (mean age 65 years). After matching, baseline demographics and rates of anxiety and depression (all P > 0.13) were similar between cohorts. The SSRI doses were standardized using quantity, duration, and strength, then stratified as low (0 to 30 mg), medium (30 to 100 mg), or high (greater than 100 mg). Multivariate regression and Kaplan-Meier analysis assessed surgical complications and revision-free survival at 2-year follow-up.
Results:
Preoperative SSRI use was associated with greater 2-year complications (5.2 versus 3.2%, P < 0.001). In adjusted multivariate analysis, SSRI use was associated with increased odds of component loosening (OR [odds ratio] 1.5), periprosthetic fracture (OR 1.8), periprosthetic joint infection (OR 1.7), dislocation (OR 2.0), and revision surgery (OR 1.7) (all P < 0.001). There was no dose-dependent relationship observed. Component loosening approached statistical significance at high SSRI doses (OR 3.7, P = 0.07). Kaplan-Meier analysis demonstrated reduced revision-free survival among SSRI users (P < 0.001) at 2-year follow-up.
Conclusion:
Preoperative SSRI use, regardless of dose, was associated with higher 2-year rates of periprosthetic joint infection, dislocation, fracture, loosening, and revision. However, the absence of a dose-response relationship suggests that SSRIs are unlikely to be directly responsible for these complications.