Use of serotonergic antidepressants and perioperative complications in patients undergoing lower limb arthroplasty: Systematic review and meta-analysis of comparative studies

TL;DR

This study finds that using serotonergic antidepressants may increase the risk of blood transfusion in patients undergoing hip or knee surgery, but more research is needed to confirm this.

Contribution

A systematic review and meta-analysis of SRIs use in arthroplasty patients, focusing on transfusion risk.

Findings

SRIs users had a 1.78 odds ratio for increased blood transfusion rates during THA and TKA.

Findings on length of stay, readmission, and revision rates were inconclusive.

High heterogeneity was observed in transfusion risk data.

Abstract

Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users.

This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model.

Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I2 = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive.

The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.

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