title: Use of selective serotonin reuptake inhibitors antidepressants and bleeding risk in breast cosmetic surgery.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressant prescribed currently. Data regarding SSRI use among plastic surgery patients may differ between different populations, but the incidence could be as high as 10 %. It is known that SSRIs decrease platelet serotonin storage and platelet function, and their association with postsurgical bleeding in mastectomy patients and orthopedic surgery patients is well established. An increased risk of postsurgical bleeding among plastic surgery patients may have important clinical implications, but this has not been evaluated to date. The authors therefore conducted a hospital-based study with prospectively collected data to examine the association between the use of SSRIs and postsurgical bleeding. To the authors' knowledge, this is the first study to evaluate the effects of SSRIs on bleeding risk in the breast cosmetic surgery population.
  
  
  METHODS
  All patients who underwent breast cosmetic plastic surgery procedures (breast augmentation, breast reduction, or mastopexy) at our institution between January of 2001 and December of 2011 were reviewed. The patients were divided into two groups by SSRI use history: a no-use group and an active-use group. The primary end point for a bleeding event was the need for intervention. Patients were further subcategorized by type of breast surgery performed, body mass index, and age. Descriptive statistics tabulated the frequency of a bleeding event within the groups. Logistic regression was applied to evaluate the risk of a bleeding event according to the use of SSRIs. The odds ratios (ORs) with their 95 % confidence intervals (CIs) associating SSRI use with postoperative bleeding were computed.
  
  
  RESULTS
  During the study period, 2,285 patients had breast cosmetic surgery, and 33 of these patients (1.44 %) experienced a bleeding event (hematoma requiring surgical draining). Of the 196 patients (8.58 %) in the active-use group, 9 (4.59 %) experienced a bleeding event. Of the 2,089 patients in the no-use group, 24 (1.15 %) presented with bleeding. The patients using SSRIs had a 4.14-fold greater risk of breast hematoma needing intervention than the patients who were not users (OR, 4; 95 % CI, 1.90-9.04). Logistic regression also showed that bleeding events were more common among the SSRI users regardless of the type of procedure performed, the body mass index, or the age group.
  
  
  CONCLUSIONS
  Use of SSRIs is associated with a fourfold increased risk of bleeding after breast cosmetic surgery (from 1.44 to 4.59 %). The decision of psychologically vulnerable patients to stop SSRIs before surgery should not be made without a complete discussion of the risks and benefits.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Basile Medical Center, Prof Joao Fiusa Avenue, 2300, Ribeirao Preto, SP, 14024-230, Brazil. fibasile@gmail.com
authors.forename: Filipe Volpe
authors.initials: FV
authors.lastname: Basile
authors.forename: Antonio Roberto
authors.initials: AR
authors.lastname: Basile
authors.forename: Vinicius Volpe
authors.initials: VV
authors.lastname: Basile
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D005260:Female; D006406:Hematoma / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors