The Effect of Psychiatric Medication Use on 1- to 3-Level Elective Lumbar Fusion Outcomes

The impact of psychiatric medication use, particularly antipsychotics, on lumbar fusion outcomes remains poorly defined. This study evaluated peri- and postoperative outcomes following 1- to 3-level lumbar fusion among patients using antidepressants or antipsychotics.

This was a single-center, retrospective cohort study of patients who underwent 1- to 3-level lumbar fusion between 2022 and 2025 at a large, academic, inner-city tertiary care hospital. Data extracted from the electronic medical record included demographic information, insurance status, Charlson Comorbidity Index, psychiatric medication use, intraoperative variables, perioperative complications, and discharge disposition. Postoperative outcomes included 90-day reoperation, readmission, emergency department visits, revision surgery, persistent radicular pain, and continued opioid use at maximum follow-up. Patients were divided into an antidepressant group (current antidepressant use with no antipsychotic use) and an antipsychotic group (current antipsychotic use regardless of antidepressant use) based on medication utilization at the time of surgery. Both treatment groups were subsequently compared with a control group (no active psychiatric medication use) using univariate and multivariate regression.

Of 615 patients, 75.6% took no psychiatric medications, 19.8% took antidepressants, and 4.6% took antipsychotics. Patients taking psychiatric medications were more likely to be women (P = 0.02) with otherwise similar baseline characteristics. On univariate analysis, both antidepressant and antipsychotic use were associated with higher revision rates (8.2% vs 3.0%, P = 0.01; 17.9% vs 3.0%, P < 0.001). Antidepressant use was also associated with increased 90-day emergency department visits (P = 0.029), readmissions (P = 0.029), and persistent opioid use (P = 0.01). In multivariate analysis, antidepressant (OR: 2.74, 95% CI: 1.177-6.398) and antipsychotic use (OR: 5.99, 95% CI: 1.954-18.362) were independently associated with revision surgery, while antidepressant use was also associated with persistent opioid use (OR: 2.07, 95% CI: 1.163-3.684).

Antidepressant and antipsychotic use were independently associated with increased odds of revision surgery following lumbar fusion. Additional studies are required to understand class-specific effects and underlying mechanisms.

The association between preoperative psychiatric medication use with poor postoperative outcomes highlights the need for further investigation into psychiatric comorbidity and clinical outcomes in spine surgery LEVEL OF EVIDENCE: 3.