San Diego, CA—March 14, 2017
People with chronic back pain also commonly suffer from depression. As a result, patients going in for spinal surgery are often taking antidepressant medications. Yet past research has shown that antidepressant use is associated with an increased risk of blood loss and need for transfusions during orthopedic procedures. A new study for the first time illuminates the impact of antidepressants on transfusion requirements in spinal surgery in particular.
The authors of the new work - a team from Hospital for Special Surgery (HSS) in New York City - reviewed the charts of 340 patients who undergone spinal fusion surgeries. They found a statistically significant association between the SSRI class of antidepressant and both increased bleeding and the need for perioperative blood transfusions.
"We set out to help define this phenomenon in a clinically significant fashion," comments lead study author Alexander P. Hughes, MD, spine surgeon at HSS. "We think our findings will help increase awareness of this risk factor among doctors so they can potentially modify their perioperative protocol."
Dr. Hughes explains that in patients undergoing spinal surgeries – especially higher risk procedures associated with more bleeding – perhaps patients can come off their SSRIs temporarily to reduce bleeding risk.
Given the increased rates of the depression in spinal surgery patients, Hughes acknowledges treating clinicians must balance the risks and benefits of stopping SSRIs in surgical patients.
"There needs to be a discussion between the patient and their clinical team, especially their psychiatrists and therapists," he says. "In patients with more minor depression, we’d be more willing to stop their antidepressant temporarily, say one week prior to surgery. In someone with severe depression, doing so might not be appropriate."
About Hospital for Special Surgery
Hospital for Special Surgery (HSS) is the world’s leading academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.