Selective Serotonin Reuptake Inhibitor Use and Intraoperative Bleeding in Urologic Surgery

Background: Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed. The prescribing information for SSRIs acknowledges these medications may increase the risk of bleeding. However, few studies on SSRI use and intra operative bleeding have been conducted. The goal of this study is to determine if bleeding is increased in urologic surgical patients on SSRIs and if those patients have an increased need for blood transfusions. Methods: A retrospective chart review was performed to collect age, preoperative hemoglobin, whether they were prescribed a SSRI (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, or escitalopram) or aspirin (ASA) at the time of surgery, if intra operative colloids were used, their estimated blood loss, and the amount of blood transfused (if applicable). Results: The study included 181 patients, of which 20 were SSRI users. The average age was 62 years old, mean preoperative hemoglobin was 13.6g/dL, and 25% were ASA users. There was no significant difference in mean blood loss (877.5mL SSRIs; 873.6mL non-SSRIs; p=0.9814) or blood transfusions between groups (p=0.6130). ASA or intra operative colloid use significantly affected the amount of blood loss (p= <0.0001). There was a significantly lower preoperative hemoglobin in patients requiring transfusions (p=0.0021) and a significantly higher percentage of transfusions required in ASA users (p=0.0024). Conclusion: No association was found between the use of SSRIs and perioperative blood loss or blood transfusions. However, ASA or intra operative colloid use could increase the amount of blood loss, and lower preoperative hemoglobin levels or ASA use may increase patients’ need for blood transfusion.