The Impact of Major Depressive Disorder on Somatic and Psychiatric Outcomes Following Elective Single-Level Lumbar...

Study DesignRetrospective database study.ObjectiveMajor depressive disorder (MDD) is common psychiatric comorbidity among lumbar fusion candidates, yet its association with postoperative psychiatric and somatic symptoms morbidity and healthcare utilization remains inadequately characterized. This study evaluated whether preoperative MDD increases the risk of adverse psychiatric and medical outcomes following single-level lumbar fusion.MethodsUtilizing a national electronic health record network, adults undergoing elective single-level lumbar fusion between 2015 and 2025 were identified. Patients with recurrent MDD diagnosed within 1-year preoperatively were compared with patients without MDD after one-to-one propensity score matching for demographics, comorbidities, laboratory values, and preoperative medications. Outcomes were assessed at 90-days and 1-year.ResultsThe matched cohort included 11 570 patient pairs. Patients with MDD demonstrated higher rates of newly diagnosed psychiatric conditions at both time points, including generalized anxiety disorder, adjustment disorder, post-traumatic stress disorder, alcohol-use disorder, and dementia; opioid-use disorder was increased at 1 year. MDD was also associated with higher rates of postoperative somatic symptom diagnoses, including chest pain, dizziness, and shortness of breath. Emergency department utilization did not differ at 90 days but was higher at 1 year, while inpatient readmission rates were increased at both time points. There were no differences in reoperation rates or mortality between cohorts.ConclusionsPreoperative MDD was associated with postoperative psychiatric morbidity, somatic symptoms, and increased healthcare utilization within 1 year following the procedure, without evidence of higher reoperation or mortality. These findings support routine depression screening and perioperative mental health optimization in single-level lumbar fusion candidates.