Patients on Antidepressants Are at an Increased Risk of Adverse Events following Total Knee Arthroplasty.

IF 2.6 2区医学 Q1 ORTHOPEDICS

Journal of the American Academy of Orthopaedic Surgeons Pub Date : 2024-12-03 DOI:10.5435/JAAOS-D-24-00743

Philip P Ratnasamy, Fortunay Diatta, Oghenewoma P Oghenesume, Joshua G Sanchez, Michael J Gouzoulis, Jonathan N Grauer

{"title":"Patients on Antidepressants Are at an Increased Risk of Adverse Events following Total Knee Arthroplasty.","authors":"Philip P Ratnasamy, Fortunay Diatta, Oghenewoma P Oghenesume, Joshua G Sanchez, Michael J Gouzoulis, Jonathan N Grauer","doi":"10.5435/JAAOS-D-24-00743","DOIUrl":null,"url":null,"abstract":"Background: A large proportion of total knee arthroplasty (TKA) patients are on antidepressant medications at the time of surgery. Postoperative outcomes of this patient demographic have not been characterized. This study compared the risk of 90-day adverse events and 5-year survival to revision surgery between patients on antidepressants and those not on antidepressants at the time of surgery.Methods: TKA patients were identified from the PearlDiver M151Ortho data set. Of these patients, those taking antidepressants (selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors) and those not taking antidepressants were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence of 90-day adverse events was determined for the two groups and compared by multivariate analyses. Five-year survival to revision surgery was compared between TKA patients on antidepressants and those not on antidepressants.Results: In total, 21.8% of TKA patients were taking antidepressants; 209,320 matched TKA patients on antidepressants and 837,066 not on antidepressants were extracted from the data set. Controlling for patient age, sex, and Elixhauser Comorbidity Index, those on antidepressants at the time of surgery had markedly higher odds of experiencing any (odds ratio [OR] 1.50), severe (OR 1.23), and minor (OR 1.61) adverse events in the 90 days following TKA (P < 0.0001 for all). Five-year survival to revision surgery of TKA patients on antidepressants was 96.4% (95% CI, 96.3% to 96.5%), compared with 96.9% (95% CI 96.8% to 96.9%) for patients not on antidepressants.Conclusions: TKA patients on antidepressants at the time of surgery were found to have markedly greater odds of experiencing 90-day postoperative adverse events but not clinically notable differences in five-year revision surgeries. TKA patients taking antidepressants could constitute a patient population at risk for inferior perioperative outcomes following surgery and thus may require additional counseling and mitigation strategies.Study design: Retrospective database study.Level of evidence: Level III.","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-00743","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: A large proportion of total knee arthroplasty (TKA) patients are on antidepressant medications at the time of surgery. Postoperative outcomes of this patient demographic have not been characterized. This study compared the risk of 90-day adverse events and 5-year survival to revision surgery between patients on antidepressants and those not on antidepressants at the time of surgery.

Methods: TKA patients were identified from the PearlDiver M151Ortho data set. Of these patients, those taking antidepressants (selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors) and those not taking antidepressants were identified and matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index scores. The incidence of 90-day adverse events was determined for the two groups and compared by multivariate analyses. Five-year survival to revision surgery was compared between TKA patients on antidepressants and those not on antidepressants.

Results: In total, 21.8% of TKA patients were taking antidepressants; 209,320 matched TKA patients on antidepressants and 837,066 not on antidepressants were extracted from the data set. Controlling for patient age, sex, and Elixhauser Comorbidity Index, those on antidepressants at the time of surgery had markedly higher odds of experiencing any (odds ratio [OR] 1.50), severe (OR 1.23), and minor (OR 1.61) adverse events in the 90 days following TKA (P < 0.0001 for all). Five-year survival to revision surgery of TKA patients on antidepressants was 96.4% (95% CI, 96.3% to 96.5%), compared with 96.9% (95% CI 96.8% to 96.9%) for patients not on antidepressants.

Conclusions: TKA patients on antidepressants at the time of surgery were found to have markedly greater odds of experiencing 90-day postoperative adverse events but not clinically notable differences in five-year revision surgeries. TKA patients taking antidepressants could constitute a patient population at risk for inferior perioperative outcomes following surgery and thus may require additional counseling and mitigation strategies.

Study design: Retrospective database study.

Level of evidence: Level III.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the American Academy of Orthopaedic Surgeons 医学-整形外科

CiteScore

6.10

自引率

6.20%

发文量

529

审稿时长

4-8 weeks

期刊介绍： The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues. Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.