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The Impact Of Selective Serotonin Reuptake Inhibitor Use On Postoperative Complications In Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Jacquelyn Roth, BA, Jamie Frost, BS, MS, Carol Wang, BA, Keisha E. Montalment, MD, MPH, Bernice Z. Yu, DO, Reanna Shah, BS, Megan Tang, BA, Esther Kim, BS, Peter W. Henderson, MD, MBA, FACS
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Purpose: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to alleviate psychological distress in breast cancer patients. By nature of their mechanism, SSRIs also reduce platelet aggregation, which has been shown to leading to increased risk of postoperative bleeding in cosmetic breast procedures including mastopexy and breast augmentation. The effect of SSRIs in autologous deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, however, remains understudied. This study aims to address this research gap by examining the association between SSRI use and DIEP flap breast reconstruction complications.
Methods: A retrospective chart review of patients who underwent DIEP flap breast reconstruction at a single institution between 2019 to 2023 was conducted. Each patient’s SSRI use status was categorized as “active” (used within the past X days) or “non-active” (defined as never used, or has not yet used with X days). Patient demographics, comorbidities, and postoperative complications (hematoma, seroma, wound dehiscence, flap necrosis, and any unexpected reoperations within 90 days) were collected, and compared between the active and non-active SSRI groups. Logistic regression analysis was performed to assess the association of SSRIs with postoperative complications. Statistical significance was set to <0.05.
Results: In total, 585 patients were identified, of which 50 (9.4%) were in the active SSRI group, and 535 (91.4%) were in the non-active group. In the active SSRI group, 44.0% (22 patients) experienced any of the post-operative complications, and in the non-active group 28.2% (151patients) experienced any post-operative complication. A 4.1-fold increased odds of flap necrosis was demonstrated with the use of SSRI at the time of surgery (p-value: 0.0; OR: 4.09; 95% CI: 2.0-8.5). There was no association between the use of SSRI at the time of surgery and dehiscence (p-value: 0.3; OR: 1.8; 95% CI: 035-5.6), hematoma (p-value: 0.4; OR: 1.7; 95% CI: 0.5-6.2), seroma (p-value: 0.8; OR: 0.8; 95% CI: 0.1-6.6), or unexpected reoperations within 90 days (p-value: 0.4; OR: 1.7; 95% CI: 0.5-6.2).
Conclusion: Active SSRI use at the time of DIEP flap breast reconstruction is associated with a higher odds of postoperative flap necrosis. Careful preoperative medication modification and patient discussion regarding the associated risks are important to optimize postoperative outcomes.
Table 1: Summary of Complications and SSRI Use | | | |
| Complication | OR | CI (95%) | p-value |
| Necrosis | 4.09 | (1.97-8.48) | 0.00 |
| Dehiscence | 1.75 | (0.55-5.59) | 0.34 |
| Hematoma | 1.68 | (0.45-6.21) | 0.44 |
| Seroma | 0.81 | (0.10-6.59) | 0.84 |
| Unexpected 90-Day Reoperation | 1.51 | (0.62-3.69) | 0.36 |
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