Preoperative Selective Serotonin Reuptake Inhibitor (SSRI) Use Is Associated With Pseudoarthrosis and Increased Opioid Utilization Across Anterior and Posterior Cervical Spine Fusion: A Propensity-Matched Cohort Analysis.

OBJECTIVE: To evaluate the association between preoperative SSRI use and postoperative outcomes after anterior and posterior cervical spinal fusion.

SUMMARY OF BACKGROUND DATA: Psychiatric comorbidities are common among patients with cervical spine pathology, and general antidepressant use has been associated with perioperative complications in spine surgery. However, the effect of SSRI exposure on outcomes after anterior and posterior cervical fusion has not been well defined.

METHODS: Patients undergoing anterior or posterior cervical fusion were identified using a large, multi-institutional database. Patients with documented SSRI use within 1 year before surgery were compared with matched controls without SSRI exposure. Propensity 1:1 score matching was performed for demographics, psychiatric diagnoses, medical comorbidities, and concurrent use of other antidepressants and gabapentinoids. Outcomes within 1 year of surgery included pseudoarthrosis, postoperative hematoma or seroma, surgical exploration, incision and drainage, infection, and postoperative opioid utilization. Risk differences and risk ratios were calculated after matching.

RESULTS: For anterior cervical fusion (N=9790 matched per group), SSRI use was associated with increased risk of pseudarthrosis (+0.9%, P=0.032) and postoperative opioid utilization (+23.9%, P<0.001), whereas risks of hematoma, exploration, incision and drainage, and infection were not significantly different. For posterior cervical fusion (N=3085 matched per group), SSRI use was associated with greater pseudoarthrosis (+2.1%, P=0.015) and strongly associated with elevated postoperative opioid use (+41.6%, P<0.001), but no significant differences were observed in the other outcome measures.

CONCLUSIONS: Preoperative SSRI use is associated with an increased risk of pseudoarthrosis and significantly higher postoperative opioid use after both anterior and posterior cervical fusion. These risks appear consistent across surgical approaches and should be considered during preoperative counseling and postoperative pain management.

STUDY DESIGN: Retrospective propensity score-matched cohort study.