Patients on antidepressants are more likely to be discharged to inpatient rehabilitation after lumbar fusion.

Abstract

The purpose of this study was to investigate the association between antidepressant use and inpatient physical therapy performance, as well as discharge disposition after surgery. Patients undergoing primary 1-3 level lumbar fusion at a single, tertiary care institution from 2017 to 2021 were retrospectively identified. Patient characteristics, surgical details, and surgical outcomes were collected via chart review. Medications were collected based on active medication lists at the patient's preoperative and first postoperative appointment-patients were considered to be taking antidepressants if prescriptions were active at both appointments. Inpatient physical therapy metrics including the distance walked during a single session (session distance) and Activity Measure for Post-Acute Care (AMPAC) scores were collected. Statistical analysis was performed to identify differences between the "antidepressant" and "no antidepressant" groups. 493 patients (27.7%) were taking antidepressants perioperatively. Patients in the antidepressant group were more likely to be female (p < 0.001), current smokers (p = 0.012), and have a higher Elixhauser comorbidity index (p < 0.001). On regression analysis, the antidepressant group was associated with discharge to inpatient rehabilitation after surgery (p = 0.026). Age (p < 0.001), length of stay (p < 0.001), 1st PT session distance walked (p < 0.001), and improvement in gait distance (p < 0.001) were associated with non-home discharge. Antidepressant use was independently associated with discharge to a rehabilitation facility. These patients were still discharged to these facilities without performing significantly worse in their inpatient physical therapy sessions. These findings suggest that psychosocial factors may play an important role in discharge disposition after spine surgery.