Self-harm After Lumbar Fusion: Incidence of and Risk Factors for a Rare But Potentially Devastating Complication

Unfortunately, some lumbar fusion patients will experience psychological distress and a deterioration of mental health postoperatively. At the extreme, these changes can lead to self-harm and suicide. This study evaluated the incidence of self-harm within 1 year of elective lumbar fusion procedures to identify risk factors for self-harm events.

The PearlDiver Mariner 170 data set from 2010 to 2023 was retrospectively analyzed. Patients undergoing 1-level to 3-level posterior lumbar fusion with minimum 1-year follow-up were included. Patients with a history of self-harm before surgery were excluded. Univariate and multivariate analyses were done to assess risk factors for self-harm. Statistical significance was assessed at P < 0.05.

In total, 138,223 patients were included. The incidence of self-harm within 1 year was 0.40% (549 patients). In the multivariable model, younger age, male sex, and higher Charlson Comorbidity Index scores were risk factors for self-harm. Specific comorbidities associated with increased risk for self-harm included alcohol use disorder, anxiety disorders, depression, tobacco use, and preoperative opioid use (all P < 0.001). The strongest associations between comorbidity and self-harm were seen for depression (odds ratio [OR] = 2.68), anxiety (OR = 2.03), and alcohol use disorder (OR = 1.89).

Self-harm is a rare, yet understudied potential complication of lumbar fusion procedures. In this national database study, the incidence of self-harm was 0.4% in the year after elective lumbar fusion. Although some risk factors for self-harm are nonmodifiable, other behavioral and mental health comorbidities may serve to flag patients as targets for early preventive intervention.