Serotonergic antidepressants are associated with increased bleeding events within 30-days after total shoulder arthroplasty: a propensity-matched analysis of 54,291 patients

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with bleeding events following orthopaedic surgery. However, their effect on total shoulder arthroplasty (TSA) outcomes is unknown. METHODS: Patients undergoing primary anatomic or reverse TSA in the United States were identified in the TriNetX database using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-10) codes. TSA for fracture was excluded. Two cohorts were created based on preoperative serotonergic antidepressant use. Cohorts were matched to 14 demographic, comorbidity, laboratory and medication parameters. Outcomes were analyzed at one week, one month and three months postoperatively. Significance was set at p < 0.05. RESULTS: 7,374 matched patients were included per cohort. The SSRI/SNRI cohort had significantly higher odds for post-hemorrhagic anemia and transfusion on the day of surgery (Anemia - OR 1.50, 95%CI 1.28–1.76; Transfusion - OR 2.55, 95%CI 1.27–5.13), at seven-days post-op (Anemia - OR 2.78, 95%CI 1.68–4.58; Transfusion - OR 2.58, 95%CI 1.39–4.79) and at one month post-op (Anemia - OR 2.73, 95%CI 1.37–5.46; Transfusion - OR 2.31, 95%CI 1.09–4.88). From one through three-months post-operatively, the two cohorts did not differ in rates of postoperative anemia, hematoma/hemorrhage, or reoperation. CONCLUSIONS: Serotonergic antidepressants were associated with a higher rate of bleeding events within 30 days postoperatively after TSA. These results are seen even when propensity matching for PT/PTT and platelet function. Complications normalize after 30 days and do not appear to pose a long-term risk.