Preoperative Antidepressants are Associated With Increased Risk of Opioid Use and Overall Complications Following Anterior and Posterior Cervical Fusion: A Nationwide Propensity-Matched Cohort Study.

Abstract

Study DesignRetrospective cohort study of a national database.ObjectivesThis study investigates the association between preoperative antidepressant use and postoperative opioid utilization as well as overall outcomes following primary anterior cervical fusion (ACF) and posterior cervical fusion (PCF).MethodsWe conducted parallel retrospective cohort analyses utilizing TriNetX for patients aged ≥18 years old with ≥2-year follow-up undergoing primary ACF and PCF between December 31, 2006, and December 31, 2022. Cohorts were thoroughly matched resulting in 4575 ACF and 3497 PCF pairs. Medical outcomes, opioid abuse, healthcare utilization, mechanical and surgical outcomes were assessed through risk ratios (RR), risk differences, <i>P</i>-values, and Kaplan-Meier analysis.ResultsAntidepressant use was associated with increased new opioid prescriptions from 2 weeks to 2 years (ACF RR 1.090-1.130, <i>P</i> < 0.001; PCF RR 1.060-1.078, <i>P</i> < 0.001), higher hospital readmissions (RR 1.484, <i>P</i> < 0.001), prolonged inpatient stays (RR 1.329, <i>P</i> < 0.001), and ED visits from 6 weeks to 2 years (ACF RR 1.150-1.184, <i>P</i> < 0.001; PCF RR 1.092-1.144, <i>P</i> ≤ 0.034). Postoperative infections were elevated at 2 years (ACF RR 1.679-2.060, <i>P</i> ≤ 0.008; PCF RR 1.375-1.677, <i>P</i> ≤ 0.020). Opioid abuse was higher at 2 years (ACF RR 2.8000, <i>P</i> = 0.003; PCF RR 2.667, <i>P</i> = 0.001), and pulmonary embolism increased in ACF at 2 years (RR 1.633, <i>P</i> = 0.032). Reoperations were elevated at 1 and 2 years (RR 1.238-1.371, <i>P</i> ≤ 0.045), with reduced 2-year reoperation-free survival in ACF (<i>P</i> = 0.001) and PCF (<i>P</i> = 0.045).ConclusionPreoperative antidepressant use is associated with significantly increased risks of postoperative opioid utilization and both medical and surgical complications, including sepsis, infections, adjacent segment disease, and reoperations, up to 2 years after primary anterior or posterior cervical fusion.