Serotonergic Antidepressants Are Associated With Higher Rates of Hematoma After Anterior Cervical Spine Surgery: A Large Propensity-Matched Cohort Analysis.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-04-01 Epub Date: 2024-10-01 DOI:10.1097/BRS.0000000000005168

Jeremy M Adelstein, Andrew J Moyal, John T Strony, Robert J Burkhart, David C Kaelber, Christina W Cheng, Zachary L Gordon, Christopher G Furey

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引用次数: 0

Abstract

Study design: Large database propensity-matched retrospective cohort analysis.

Objective: This study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery. It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after anterior cervical spine surgery.

Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopedic procedures.

Materials and methods: A retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included through Current Procedural Terminology codes and the International Classification of Disease, 10th Revision, encounter diagnosis codes. Cohorts were 1:1 propensity-matched across 7 demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as health care utilization, within 14 days, 30 days, 90 days, and 2 years postoperatively was evaluated.

Results: Following propensity matching, each cohort consisted of 9249 patients, for a total of 18,498 patients included in the final statistical analysis. SSRIs/SNRIs were associated with higher odds of hematoma formation within 7 days [0.69% vs . 0.46%, odds ratio (OR): 1.5 (95% CI: 1.02-2.2), P = 0.04] and within 14 days postoperatively [0.81% vs . 0.52%, OR: 1.6 (95% CI: 1.1-2.3), P = 0.01]. Within 30 and 90 days, SSRIs/SNRIs were associated with a higher risk of emergency department utilization [30 d, OR: 1.30 (1.1-1.4); 90 d, OR: 1.3 (1.2-1.4)] and irrigation & debridement (I&D; 30 d, OR: 1.9 (1.2-3.0)]. SSRIs/SNRIs were also associated with a significantly higher risk of I&D within 2 years [OR: 1.3 (1.1-1.6)].

Conclusion: The use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization, and the need for irrigation and debridement. Future prospective studies are required to confirm these results.

Level of evidence: Level III-retrospective cohort analysis.

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羟色胺能抗抑郁药与颈椎前路手术后血肿发生率较高有关：一项大型倾向匹配队列分析

研究设计大型数据库倾向匹配回顾性队列分析：本研究旨在探讨血清素能抗抑郁药对颈椎前路手术（ACSS）术后效果的潜在影响。假设围手术期使用血清素能抗抑郁药与 ACSS 术后血肿形成率升高和预后恶化有关：选择性血清素再摄取抑制剂（SSRIs）和血清素-去甲肾上腺素再摄取抑制剂（SNRIs）与骨科手术后较差的预后有关：使用TriNetX进行了一项回顾性队列分析，TriNetX是一个汇总和去标识化的电子健康记录平台。接受颈椎前路手术的患者通过当前程序术语（CPT）代码和国际疾病分类（ICD-10）相遇诊断代码纳入研究。在七个人口统计学和医学合并症参数上对组群进行了 1:1 的倾向匹配，并对结果进行了比较。对术后 14 天、30 天、90 天和 2 年内不良后果的发生率以及医疗保健使用情况进行了评估：经过倾向匹配后，每个队列中有 9,249 名患者，共有 18,498 名患者纳入最终统计分析。SSRI/SNRI与术后7天内（0.69% vs. 0.46%，OR 1.5 [95% CI 1.02-2.2]，P=0.04）和14天内（0.81% vs. 0.52%，OR 1.6 [95% CI 1.1-2.3]，P=0.01）血肿形成几率较高相关。在 30 天和 90 天内，SSRI/SNRI 与较高的急诊使用风险（30 天 OR 1.30 [1.1-1.4]；90 天 OR 1.3 [1.2-1.4]）和冲洗与清创（I&D）风险（30 天 OR 1.9 [1.2-3.0]）相关。SSRIs/SNRIs也与2年内发生I&D的风险显著升高有关（OR 1.3 [1.1-1.6]）：结论：围手术期使用血清素能抗抑郁药与血肿形成、使用急诊科以及需要冲洗和清创等多种结果的几率和风险较高有关。需要未来的前瞻性研究来证实这些结果：证据等级：III；回顾性队列分析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.