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

Background Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake 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 postoperative bleeding. The aim of this paper was to determine if SSRIs/SNRIs increase the risk of postoperative hematoma formation following traumatic elbow surgery. Methods 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 preoperatively (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. Results Over 6,000 patients were included in the initial query. 985 patients were included in the control group (no SSRI/SNRI) and 2,494 patients in the treatment (SSRI/SNRI) group after propensity-score matching. At 30-days postoperatively, patients in the treatment group had a significantly greater rate of surgical site infection (3.4% versus 2.2%; P =0.04). There was no significant difference in rates of 30-day hematomas between the two cohorts. At 90-days postoperatively, there was a statistically significant difference in complications for patients treated with SSRI/SNRIs, including a higher rate of surgical site infection (5.4% versus 3.3%; P =0.01) and hematoma formation (1.2% versus 0.6%; P =0.04). Conclusions SSRIs and SNRIs are commonly prescribed to patients for a variety of psychiatric conditions. These medications often go unnoticed in the preoperative surgical assessment; however, this retrospective study suggests an association between SSRI/SNRI use and higher odds of surgical site infection and hematoma formation.