The Effect of Psychiatric Medication Use on 1- to 3-Level Elective Lumbar Fusion Outcomes
In brief
Antipsychotic users had nearly sixfold higher odds of lumbar fusion revision
In this single-center study of 615 patients, antipsychotic use was associated with nearly six times the adjusted odds of revision surgery after lumbar fusion; antidepressant use was associated with nearly three times the odds and with continued opioid use. Because only 4.6% used antipsychotics and the study was retrospective, further research is needed to clarify whether medication or related factors explain the risks.
- Journal
- International journal of spine surgery (Q1)
- Published
- 13 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Regina Golding, Jacqueline Albert, Arjun Gupta, Xiuyi Yang, Priya Singh, Shreya Balusu, et al.
- PMID
- 42869666
- DOI
- 10.14444/8964
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 19 October 2026): Retrospective cohort of lumbar fusion outcomes
Abstract
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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. CLINICAL RELEVANCE: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.