下肢关节置换术患者血清素能抗抑郁药的使用和围手术期并发症：比较研究的系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-07-18 DOI:10.1016/j.jor.2025.07.009

Dimitrios Grammatikopoulos , Eustathios Kenanidis , Georgios Foukarakis , Christothea-Alexandra Tsiridis , Michael Potoupnis , Eleftherios Tsiridis

{"title":"下肢关节置换术患者血清素能抗抑郁药的使用和围手术期并发症：比较研究的系统回顾和荟萃分析","authors":"Dimitrios Grammatikopoulos , Eustathios Kenanidis , Georgios Foukarakis , Christothea-Alexandra Tsiridis , Michael Potoupnis , Eleftherios Tsiridis","doi":"10.1016/j.jor.2025.07.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users.</div></div><div><h3>Methods</h3><div>This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model.</div></div><div><h3>Results</h3><div>Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I<sup>2</sup> = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive.</div></div><div><h3>Conclusion</h3><div>The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 318-325"},"PeriodicalIF":1.5000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Use of serotonergic antidepressants and perioperative complications in patients undergoing lower limb arthroplasty: Systematic review and meta-analysis of comparative studies\",\"authors\":\"Dimitrios Grammatikopoulos , Eustathios Kenanidis , Georgios Foukarakis , Christothea-Alexandra Tsiridis , Michael Potoupnis , Eleftherios Tsiridis\",\"doi\":\"10.1016/j.jor.2025.07.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users.</div></div><div><h3>Methods</h3><div>This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model.</div></div><div><h3>Results</h3><div>Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I<sup>2</sup> = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive.</div></div><div><h3>Conclusion</h3><div>The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.</div></div>\",\"PeriodicalId\":16633,\"journal\":{\"name\":\"Journal of orthopaedics\",\"volume\":\"67 \",\"pages\":\"Pages 318-325\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0972978X25002739\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0972978X25002739","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：血清素再摄取抑制剂（SRIs）是西方国家人群中常用的抗抑郁药；然而，它们的使用与不良反应和术后并发症有关。本系统综述评估了选择性全髋关节置换术（THA）和膝关节置换术（TKA）的SRIs使用者与非SRIs使用者相比，早期和晚期围手术期并发症的风险。方法本研究遵循2020年PRISMA指南。对PubMed、Science Direct/Scopus和Cochrane系统评价数据库进行了全面的检索，从成立到2025年1月。比较研究纳入了SRI使用者和非使用者进行选择性THA或TKA，并解决了至少一个术后结果（失血、术后血红蛋白降低、输血率、住院时间、再入院和翻修率）。采用纽卡斯尔-渥太华量表评价纳入研究的质量。采用随机效应模型进行荟萃分析以评估输血风险。结果本分析纳入了10项比较队列研究，包括2项前瞻性研究和8项回顾性研究，涉及2,098,833例接受选择性THA或TKA的患者。在这些患者中，418,527例患者在围手术期使用SRIs，平均年龄为65.2岁。我们的荟萃分析显示优势比为1.78 (95% CI, 1.11, 2.83；p = 0.02)关于使用SRIs患者的输血率，尽管其特征具有相当大的异质性（I2 = 97%）。关于住院时间、再入院率和复查率的研究结果尚无定论。结论：选择性全髋关节置换术和全髋关节置换术患者使用SRIs可能与出血风险和输血需求的轻微增加有关。然而，考虑到这些药物对该患者群体的潜在益处，在围手术期停药是否可取尚不确定。需要更多高质量的研究来确定病因关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Use of serotonergic antidepressants and perioperative complications in patients undergoing lower limb arthroplasty: Systematic review and meta-analysis of comparative studies

Background

Serotonin Reuptake Inhibitors (SRIs) are commonly utilised antidepressants among populations in Western countries; however, their use has been linked to adverse effects and postoperative complications. This systematic review assessed the risk of both early and late perioperative complications in SRIs users undergoing elective total hip arthroplasty (THA) and knee arthroplasty (TKA) compared to non-users.

Methods

This study adhered to the 2020 PRISMA guidelines. A comprehensive search of PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews was conducted from inception until January 2025. Comparative studies examining SRI users and non-users undergoing elective THA or TKA that addressed at least one postoperative outcome (blood loss, postoperative haemoglobin reduction, transfusion rate, length of stay, readmission and revision rate) were included. The Newcastle-Ottawa Scale was employed to evaluate the quality of the included studies. A meta-analysis was performed to assess the risk of transfusion, utilising a random-effects model.

Results

Ten comparative cohort studies, including two prospective and eight retrospective studies, were included in this analysis, involving 2,098,833 patients who underwent either elective THA or TKA. Among these patients, 418,527 were using SRIs during the perioperative period, with a mean age of 65.2 years. Our meta-analysis revealed an odds ratio of 1.78 (95 % CI, 1.11, 2.83; p = 0.02) concerning the blood transfusion rate in patients utilising SRIs, although it was characterised by considerable heterogeneity (I² = 97 %). The findings regarding length of stay, readmission rate, and revision rate were inconclusive.

Conclusion

The use of SRIs in patients undergoing elective THA and TKA may be linked to a slightly increased risk of bleeding and need for blood transfusion. However, considering the potential benefits of these medications for this patient group, it remains uncertain whether discontinuing them during the perioperative period is advisable. More high-quality studies are required to establish an etiological relationship.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.