Association between preoperative antidepressant use and early outcomes after lumbar spinal fusion

Purpose: This study evaluated whether documented preoperative antidepressant use was associated with early outcomes after lumbar spinal fusion, with particular emphasis on postoperative gabapentinoid use.Materials and Methods: A retrospective cohort study of adults who underwent lumbar fusion have been performed. Patients with documented regular antidepressant use before surgery were compared with patients without antidepressant use. The primary endpoint was postoperative gabapentinoid use. Secondary endpoints included complications, length of stay, in-hospital mortality, and 90-day readmission. Antidepressant exposure was also analyzed by medication class.Results: Among 1,628 screened elective spinal fusion patients, 183 (11.2%) had documentation of antidepressant use and 154 met all inclusion/exclusion criteria for the final cohort: 120 controls and 34 antidepressant users. Antidepressant users were more often female (64.7% vs. 51.8) and had higher Elixhauser (1.92 vs. 1.38) and Charlson comorbidity indices (0.84 vs. 0.72). Postoperative gabapentinoid use was more frequent among patients receiving SSRIs, SNRIs, and atypical antidepressants. Complications and 90-day readmission (8.8% vs. 7.5%) ere not statistically different between groups.Conclusion: Preoperative antidepressant use was associated with higher postoperative gabapentinoid use after lumbar spinal fusion, particularly among SSRI, SNRI, and atypical antidepressant users. These findings should be interpreted as associations rather than evidence that antidepressants directly cause postoperative medication requirements.