ASSOCIATIONS BETWEEN SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND ADVERSE EVENTS FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY

Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed anti-depressant medication and are increasing used for anxiety, pain, insomnia, and minor depressive symptoms. Unfortunately, they are known to be associated with lower bone mineral density, increased bleeding, higher infection rates and exert negative effects on bone-implant osseointegration. The purpose of this study was to test for associations between SSRIs and post-surgical adverse events for Total Hip and Knee Arthroplasty patients. Provincial health utilization data were used to select all Total Hip (THA) and Total Knee (TKA) Arthroplasty procedures from 2017–2021. Provincial prescription (RX) data was used to identify cases which had an SSRI RX filled in the 180 day period prior to surgery. Outcomes studied were emergency department (ED) visits, infection, mortality, and revision in the 180-day follow-up period. Inverse probability of treatment weights (IPTW) were generated for each case to reduce the impact of confounders. Logistic regression was used to test for difference between SSRIs and study outcomes controlling for age, sex, co-morbidities, hospital, admission from home and distance to care. Chi-squared statistics at 95% confidence level were used to test for statistical significance. There were 12259 TKA patients and 7971 THA patients included in the study. Of those 1794 TKA (29.6%) and 975 THA (12.2%) had an SSRI RX filled in the 180 days prior to surgery. The primary outcomes analyzed for this study were infection, emergency department visit (ED), mortality, revision, bleeding event, and blood transfusion. For TKA the only statistically significant change with SSRI use was increased ED visits post TKA. There was a more pronounced effect of SSRIs for THA with significant increase in infection, ED visits, revision, and blood transfusion. Hierarchical linear models with inverse propensity treatment weighted regressions were performed to limit bias in the analysis. IPTW-weighted ED visits where higher for those with an SSRI RX with TKA OR 1.18 [CI 1.04–1.34], whereas infection, ED visits, revision, bleeding event and blood transfusion were all higher for THA. Multivariate results for THA showed odds ratios of 1.59 [CI 1.03–2.44], 1.24 [CI 1.04–1.47], 1.73 [CI 1.14–2.62], 1.52 [CI 1.06–2.18] and 1.72 [CI 1.11–2.66] for Infection, ED visits, revision, bleeding event, and blood transfusion respectively. SSRIs are commonly prescribed for TKA and THA patients and can lead to serious adverse events following arthroplasty. The association with negative outcomes was particularly noted with THA recipients. Surgeons should discuss SSRI RX history with patients and develop strategies to mitigate risk.