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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic of musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.