Opioid use and complications following short-segment fusions in patients with psychiatric disorders

The rising prevalence of psychiatric disorders significantly impacts surgical outcomes. These conditions can adversely affect pain perception and recovery trajectories following lumbar spine procedures. The aim of this study was to investigate the association between specific psychiatric disorders and postoperative opioid use, complications, and 30-day readmission rates after transforaminal lumbar interbody fusion (TLIF).

A retrospective matched cohort study using a national administrative database included patients with and those without psychiatric diagnoses who underwent short-segment TLIF (≤ 3 levels) between January 2018 and April 2022. Patients were exactly matched 1:1 based on demographics and comorbidities. Psychiatric conditions assessed were anxiety disorders, behavioral disorders, depression, impulse control disorders, and schizophrenia. Outcomes measured included postoperative opioid use beyond 30 days, mean morphine milligram equivalents (MME) per day, 30-day readmission rates, and incidences of medical and surgical complications. Multivariate logistic regression was used to delineate independent effects on outcome variables.

Patients with psychiatric comorbidities had significantly greater opioid use beyond 30 days postoperatively (90.94% vs 79.48%; OR 2.59, 95% CI 2.48-2.71; p < 0.001) and greater mean MME per day (50.68 ± 50.97 mg vs 46.10 ± 46.99 mg; p < 0.001). Specific psychiatric conditions linked to increased opioid requirements included anxiety disorders (OR 1.26, 95% CI 1.16-1.36; p < 0.001), depression (OR 1.52, 95% CI 1.40-1.64; p < 0.001), behavioral disorders (OR 1.46, 95% CI 1.16-1.86; p = 0.002), and impulse control disorders (OR 4.88, 95% CI 1.54-29.62; p = 0.027). The 30-day readmission rate was higher in patients with psychiatric comorbidities (2.25% vs 1.88%; OR 1.20, 95% CI 1.08-1.34; p < 0.001). Depression (OR 1.15, 95% CI 0.99-1.34; p = 0.057) and schizophrenia (OR 1.83, 95% CI 1.35-2.48; p < 0.001) were associated with increased readmission rates. Patients with psychiatric diagnoses had higher incidences of composite medical complications (15.49% vs 5.20%; OR 3.34, 95% CI 3.16-3.53; p < 0.001) and surgical complications (4.07% vs 2.39%; OR 1.73, 95% CI 1.58-1.89; p < 0.001).

Psychiatric comorbidities are associated with increased postoperative opioid requirements, higher complication rates, and greater 30-day readmissions following TLIF. Preoperative identification and personalized management of psychiatric conditions might improve postoperative outcomes and optimize healthcare resource utilization.