Prior Antidepressant Prescription Is Associated With Greater Opioid Prescriptions and Complications in Cervical Spine Surgery: A Propensity Matched Cohort Study.

Abstract

Retrospective cohort study of national database. This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery. Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery. Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months. In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P <0.0001), 6 months (OR 1.36, P <0.0001), 12 months (OR 1.36, P <0.0001), and 24 months (OR 1.33, P <0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P =0.0082) and 24 months (OR 1.083, P =0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P =0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P =0.0013) and 24 months (OR 1.18, P <0.0001). Adjacent segment disease (OR 1.54, P <0.0001 at 24 mo), hardware failure (OR 1.42, P =0.013 at 24 mo), and pseudarthrosis (OR 1.48, P <0.0001 at 24 mo) were also significantly higher in the ADP group. Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications. III.