Preoperative Serotonin Antidepressants Are Associated With Increased Postoperative Complications Following Rhinoplasty: A Propensity Score–Matched Analysis

BACKGROUND: Rhinoplasty is a common facial aesthetic procedure, but a high proportion of candidates for rhinoplasty present with anxiety and depressive disorders. Serotonergic antidepressants are widely used to manage these disorders, and recent reports linking these medications to increased postoperative complications suggest that it is important to assess whether their use carries a higher risk of complications following rhinoplasty. OBJECTIVES: The aim of this study was to evaluate the association between preoperative serotonergic antidepressant use and the incidence of postoperative complications following rhinoplasty. METHODS: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients aged >18 years who had undergone rhinoplasty were divided into 2 groups: those who had documented serotonergic antidepressant use prior to surgery; and those with no history of serotonergic antidepressant use. Propensity score matching was applied to balance demographic and clinical variables. Primary outcomes included postoperative complications at 3 time intervals: 30 days, 60 days, and 90 days. Secondary outcomes included long-term complications after 1 year. RESULTS: After 1:1 propensity score matching, each cohort consisted of 4917 patients. Within 30 days following rhinoplasty, patients in the serotonergic cohort had a significantly increased risk of readmission (relative risk [RR], 1.793; P = .01), opioid use (RR, 1.361; P < .0001), and bleeding/hematoma rates (RR, 1.596; P = .005) compared with the control cohort. These risks persisted at 60 and 90 days postsurgery. For long-term outcomes, comparable rates of surgical revision rates were noted after 1 year. CONCLUSIONS: Serotonergic antidepressant use is associated with increased risk for short-term postoperative complications following rhinoplasty surgery. LEVEL OF EVIDENCE: 3 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.