Selective Serotonin Reuptake Inhibitor Use and Total Joint Arthroplasty Outcomes: A Systematic Review and Meta-Analysis with Emphasis on Transfusion Risk

Objectives: This systematic review and meta-analysis aimed to evaluate the association between selective serotonin reuptake inhibitor (SSRI) use and complications and outcomes after total joint arthroplasty (TJA). Methods: We systematically searched four databases for studies comparing outcomes between SSRI users and non-users undergoing TJA. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the ROB-۲ tool for randomized controlled trials (RCTs). Meta-analyses were performed using a random-effects model, with subgroup and sensitivity analyses used to explore between-study heterogeneity. Results: Eight reports involving ۱۶۲,۳۲۹ study-level patient observations were included. SSRI use was associated with a significantly higher risk of transfusion (OR: ۱.۵۰, ۹۵% CI: ۱.۲۲–۱.۸۵, p < ۰.۰۰۰۱). Narrative findings also suggested longer hospital stays and higher readmission rates among SSRI users. However, the evidence was insufficient to draw firm conclusions regarding functional outcomes, quality of life, pain, periprosthetic joint infection (PJI), or revision surgery. Conclusion: Clinicians should balance the quantitatively demonstrated increase in transfusion risk among SSRI users against the potential mental health consequences of abrupt SSRI discontinuation, including withdrawal symptoms or relapse of depression. The evidence remains insufficient to draw firm conclusions regarding functional outcomes, quality of life, pain, PJI, or revision surgery. Level of evidence: III

کلیدواژه ها:

Depression ، Length of stay ، SSRI ، systematic review and meta-analysis ، Total hip arthroplasty ، Total knee arthroplasty ، Transfusion