TY - JOUR
T1 - Perioperative inpatient use of selective serotonin reuptake inhibitors is associated with a reduced risk of THA and TKA revision
AU - Yao, Jie J.
AU - Kremers, Hilal Maradit
AU - Kremers, Walter K.
AU - Lewallen, David G.
AU - Berry, Daniel J.
N1 - Publisher Copyright:
© 2018 by the Association of Bone and Joint Surgeons.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background Depression is common in the general population, and so it is likewise common among patients undergoing THA and TKA.Depression is associated with lower perioperative patient-reported outcomes and an increased risk of postoperative complications. Antidepressants are effective in managing symptoms of depression and may potentially contribute to better functional status and better clinical outcomes after THA and TKA.Questions/purposes We examined (1) whether perioperative depression is associated with all-cause revisions, revisions for aseptic loosening, revisions without infection, and periprosthetic joint infections (PJIs) in patients undergoing THA and TKA;and (2) whether perioperative antidepressant use reduces the risk of all-cause revisions,revisions for aseptic loosening, aseptic revisions,and PJIs in patients undergoing THA and TKA. Methods This was a retrospective study of adult patients ($ 18 years) who underwent 20,112 primary and revision THAs and TKAs from January 1,2002, through December 31, 2009,at a large US tertiary care hospital. Data on patient and surgery characteristics and outcomes (dates and types of revisions,death) were ascertained through the institutional joint registry.Perioperative antidepressant use was assessed by searching the daily medication administration records beginning at admission and ending at discharge. A diagnosis of depression was present in 4466 (22%), and antidepressants were administered at the time of 5077 (25%) surgical procedures. Multivariable Cox proportional hazard models were used to estimate associations between antidepressant use and the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions,and PJIs. Results Depression was associated with an increased risk of all-cause revisions (hazard ratio [HR],1.73; 95% confidence interval [CI],1.42-2.02; p<0.001) and PJIs (HR, 2.23; 95%CI,1.53-3.17; p< 0.001).Overall,perioperative antidepressant use was not associated with the risk of revision or PJI,but selective serotonin reuptake inhibitor (SSRI) users had a lower risk of all-cause revisions (HR, 0.77;95% CI, 0.61-0.96; p=0.001) and aseptic revisions (HR, 0.72; 95% CI,0.56-0.93;p=0.013).Conclusions The presence of a depression diagnosis confers an increased risk of revisin and PJI among patients undergoing THA and TKA, yet the risk is lower within the subset of patients who received SSRIs during the perioperative period. Future longitudinal studies with detailed antidepressant medication histories are warranted to better understand the potential biologic effects of SSRI on the risk of revision in patients undergoing THA and TKA. Level of Evidence Level III,therapeutic study.
AB - Background Depression is common in the general population, and so it is likewise common among patients undergoing THA and TKA.Depression is associated with lower perioperative patient-reported outcomes and an increased risk of postoperative complications. Antidepressants are effective in managing symptoms of depression and may potentially contribute to better functional status and better clinical outcomes after THA and TKA.Questions/purposes We examined (1) whether perioperative depression is associated with all-cause revisions, revisions for aseptic loosening, revisions without infection, and periprosthetic joint infections (PJIs) in patients undergoing THA and TKA;and (2) whether perioperative antidepressant use reduces the risk of all-cause revisions,revisions for aseptic loosening, aseptic revisions,and PJIs in patients undergoing THA and TKA. Methods This was a retrospective study of adult patients ($ 18 years) who underwent 20,112 primary and revision THAs and TKAs from January 1,2002, through December 31, 2009,at a large US tertiary care hospital. Data on patient and surgery characteristics and outcomes (dates and types of revisions,death) were ascertained through the institutional joint registry.Perioperative antidepressant use was assessed by searching the daily medication administration records beginning at admission and ending at discharge. A diagnosis of depression was present in 4466 (22%), and antidepressants were administered at the time of 5077 (25%) surgical procedures. Multivariable Cox proportional hazard models were used to estimate associations between antidepressant use and the risk of all-cause revisions, revisions for aseptic loosening, aseptic revisions,and PJIs. Results Depression was associated with an increased risk of all-cause revisions (hazard ratio [HR],1.73; 95% confidence interval [CI],1.42-2.02; p<0.001) and PJIs (HR, 2.23; 95%CI,1.53-3.17; p< 0.001).Overall,perioperative antidepressant use was not associated with the risk of revision or PJI,but selective serotonin reuptake inhibitor (SSRI) users had a lower risk of all-cause revisions (HR, 0.77;95% CI, 0.61-0.96; p=0.001) and aseptic revisions (HR, 0.72; 95% CI,0.56-0.93;p=0.013).Conclusions The presence of a depression diagnosis confers an increased risk of revisin and PJI among patients undergoing THA and TKA, yet the risk is lower within the subset of patients who received SSRIs during the perioperative period. Future longitudinal studies with detailed antidepressant medication histories are warranted to better understand the potential biologic effects of SSRI on the risk of revision in patients undergoing THA and TKA. Level of Evidence Level III,therapeutic study.
UR - http://www.scopus.com/inward/record.url?scp=85053851701&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053851701&partnerID=8YFLogxK
U2 - 10.1007/s11999.0000000000000098
DO - 10.1007/s11999.0000000000000098
M3 - Article
C2 - 29432263
AN - SCOPUS:85053851701
SN - 0009-921X
VL - 476
SP - 1191
EP - 1197
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 6
ER -