Asian Spine J.  2017 Aug;11(4):601-609. 10.4184/asj.2017.11.4.601.

Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery

• Schadler P
• Shue J
• Moawad M
• Girardi FP
• Cammisa FP
• Sama AA
• Huang RC
• Lebl DR
• Craig CM
• Hughes AP

• KMID: 2387666
• DOI: http://doi.org/10.4184/asj.2017.11.4.601

Abstract

STUDY DESIGN: Retrospective case-control study. PURPOSE: The purpose of this study was to examine the effect of antidepressants on blood loss and transfusion requirements in spinal surgery patients. OVERVIEW OF LITERATURE: Several studies have shown an increase in perioperative bleeding in orthopedic surgery patients on antidepressant drug therapy, yet no study has examined the impact of these agents on spinal surgery patients.
METHODS
Charts of patients who underwent single-level spinal fusion (posterior lumbar interbody fusion with posterior instrumentation) performed by five fellowship-trained surgeons at a tertiary spine center between 2008 and 2013, were retrospectively reviewed. Exclusion criteria included select medical comorbidities, select drug therapy, and Amercian Society of Anesthesiologists Physical Status Classification score of greater than 2. Serotonergic antidepressants were examined in multivariate analysis to assess their predictive value on estimated blood loss and risk of transfusion.
RESULTS
A total of 235 patients, of which 52% were female, were included. Allogeneic blood was transfused in 7% of patients. The average estimated blood loss was 682±463 mL. Selective serotonin reuptake inhibitors were taken by 10% of all patients. Multivariable regression analysis showed that intake of selective serotonin reuptake inhibitors was a significant predictor for blood loss (average increase of 34%, p=0.015) and for the need of allogeneic blood transfusion (odds ratio, 4.550; p=0.029).
CONCLUSIONS
There was a statistically significant association between selective serotonin reuptake inhibitors and both increased blood loss and risk of allogeneic red blood cell transfusion. Surgeons and perioperative providers should take these findings into account when assessing patients' preoperative risk for blood loss and transfusion.

Keyword

Lumbar spine; Spondylosis; Spinal fusion; Antidepressive agents; Blood transfusion

MeSH Terms

Antidepressive Agents*
Blood Transfusion
Case-Control Studies
Classification
Comorbidity
Drug Therapy
Erythrocyte Transfusion
Female
Hemorrhage
Humans
Multivariate Analysis
Orthopedics
Retrospective Studies
Serotonin Uptake Inhibitors
Spinal Fusion
Spine
Spondylosis
Surgeons
Antidepressive Agents
Serotonin Uptake Inhibitors