Serotonergic Antidepressants and Postoperative Hematoma Risk After Abdominoplasty: A Study Utilizing Propensity Score Matching

Abstract Background The incidence of psychiatric disorders, particularly major depressive disorder, is increasingly observed among patients undergoing plastic surgery procedures. This trend has raised concerns about the impact of serotonergic antidepressants on postoperative complications, especially the incidence of hematomas. Objectives The aim of this study was to investigate the risk of developing postoperative hematoma after abdominoplasty in patients who did or did not use serotonergic antidepressants before surgery. Methods Data from TriNetX was utilized to identify female patients who underwent abdominoplasty. Patients were classified in 2 cohorts: the exposure cohort included patients with serotonergic antidepressant use, and the control cohort included patients who did not take these medications. Propensity score–matching analyses were performed to adjust for bleeding risk factors. Hematoma diagnosis was the primary outcome; other outcomes included seroma, wound dehiscence, surgical site infection, blood transfusion, and hematoma/seroma evacuation. All outcomes were assessed at 7, 15, and 30 days following surgery. Results After matching for the 7-day outcomes analysis, each group contained 5882 individuals. Patients who were taking serotonergic antidepressants had a significantly increased risk of hematoma (risk ratio [RR] 1.95, P < .001), transfusion (RR 1.57, P = .007), and hematoma/seroma evacuation (RR 1.65, P = .004) within 7 days postsurgery. Similar results were observed at 15 and 30 days after surgery. Conclusions Patients who took serotonergic antidepressants before surgery had an increased risk of hematoma and other related complications after abdominoplasty. These findings underscore the need for preoperative counseling and risk assessment in this population. Level of Evidence: 3 (Therapeutic)