Preoperative Serotonin Antidepressant Use Is Associated With Increased Postoperative Complications Following Breast Reduction: A Propensity-Score-Matched Analysis of a Multi-institutional Database

Abstract Background Serotonergic antidepressants have been associated with an increased risk of weight gain. Because being overweight is strongly linked to macromastia development, which is a primary indication for breast reduction, it is very important to assess whether these medications pose the risk of postoperative complications. Objectives The aim of this study was to evaluate the association between preoperative serotonergic antidepressant use and the incidence of postoperative complications following breast reduction. Methods A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Female patients >18 years old who underwent breast reduction were divided into 2 groups: those with 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 and 2 years. Results After 1:1 propensity score matching, each cohort consisted of 8625 patients. Within 30 days following breast reduction, patients in the serotonergic cohort had a significantly increased risk of surgical site infection (risk ratio [RR], 1.42; P = .003), wound dehiscence (RR, 1.524; P < .0001), inpatient hospitalization (RR, 1.375; P = .004), opioid use (1.474, P < .0001), and any surgical site complication (1.28, P < .0001) compared with the control cohort. These elevated risks persisted at 60 and 90 days postsurgery. For long-term outcomes, similar rates were noted after 1 and 2 years. Conclusions Serotonergic antidepressant use is associated with an increased risk of short-term postoperative complications following breast reduction surgery. Level of Evidence: 2 (Therapeutic)