# Associations between selective serotonin reuptake inhibitors and adverse events following hip fracture arthroplasty: a retrospective cohort study

## TL;DR

This study found that using SSRIs before hip fracture surgery is linked to higher risks of adverse outcomes like emergency visits and mortality.

## Contribution

The study identifies specific associations between SSRI use and post-surgical adverse events in hip fracture patients using a large retrospective cohort.

## Key findings

- SSRI use was associated with increased odds of emergency department visits, mortality, revision surgery, and bleeding events.
- Blood transfusion outcomes were not significantly different between SSRI users and non-users.
- The findings suggest that SSRI use should be considered and managed pre-surgery to reduce risks.

## Abstract

Hip fractures are a priority topic while selective serotonin reuptake inhibitors (SSRI) use is increasing. Surgical outcomes over longer follow-up periods for hip fracture patients on SSRIs is unclear. The purpose of this study was to test for associations between SSRIs and post-surgical adverse events for hip fracture arthroplasty patients.

Hospital data were used to select patients who had hip fracture arthroplasty surgery in Nova Scotia, Canada from 2016 to 2022. Patients who filled an SSRI prescription (Rx) in the 180-day period prior to surgery were identified. Study outcomes were any emergency department (ED) visit, mortality, revision, and major bleeding within 180 days of discharge as well as a blood transfusion during admission. Multivariate hierarchical logistic models weighted by inverse probability treatment weights were estimated to test for associations between SSRI use and outcomes.

An SSRI prescription was filled in the 180-day pre-surgery period for (883) 29.9% of the 2946 cases. Adjusted odds ratios were higher for those on an SSRI for an ED visit (1.68 CI, 1.40–2.01; p < 0.0001), mortality (1.26 CI, 1.02–1.55; p = 0.036), revision (2.35 CI, 1.36–4.06; p = 0.0022), and bleeding event (1.48 CI 1.06–2.07; p = 0.022). Blood transfusion was statistically insignificant.

SSRI use was associated with worse outcomes for hip fracture patients for four of five study outcomes. SSRI use should be discussed prior to surgery to mitigate the likelihood of adverse events.