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Purpose <p>Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are widely prescribed and may influence perioperative bleeding risk and fusion biology. This study evaluated the association between preoperative SSRI/SNRI use and postoperative outcomes following transforaminal lumbar interbody fusion (TLIF).</p> Methods <p>A retrospective propensity score–matched cohort study was conducted using a multi-institutional electronic medical record database. Adult patients undergoing single- or multi-level TLIF between 2004 and 2024 were identified using CPT codes 22,633 and 22,634. The exposure group included patients prescribed SSRIs/SNRIs within two years before surgery. Exclusion criteria included infection, malignancy, inflammatory bone disease, prior lumbar fusion, and documented pseudoarthrosis. Matching (1:1) was performed across demographics and &gt; 300 comorbidities. Outcomes were assessed at 30, 90 days, and 2-, and 5-year intervals using chi-squared tests and t-tests.</p> Results <p>After propensity matching, 14,536 patients undergoing single-level TLIF and 4,386 patients undergoing multi-level TLIF were included. At 30 days, SSRI/SNRI use was associated with significantly higher rates of infection and opioid utilization in both cohorts. At 90 days, SSRI/SNRI use was associated with higher rates of pneumonia, incision and drainage, and opioid utilization in single-level TLIF. Among multi-level TLIF, SSRI/SNRI use was associated with increased opioid and emergency department utilization. At two years, SSRI/SNRI use was associated with higher rates of pseudoarthrosis and adjacent segment disease following single-level TLIF. Among multi-level TLIF, SSRI/SNRI use was associated with higher rates of reoperation at five years.</p> Conclusion <p>Preoperative SSRI/SNRI use was independently associated with increased short- and long-term complications following TLIF, underscoring the importance of incorporating antidepressant exposure into perioperative risk assessment.</p>

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Impact of serotonergic modulators on short- and long-term outcomes after transforaminal lumbar interbody fusion: a national propensity-matched cohort study

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Robert J. Ferdon,
  • Charles L. Shissias,
  • Charles A. Reitman,
  • Robert A. Ravinsky,
  • Jason Silvestre

摘要

Purpose

Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are widely prescribed and may influence perioperative bleeding risk and fusion biology. This study evaluated the association between preoperative SSRI/SNRI use and postoperative outcomes following transforaminal lumbar interbody fusion (TLIF).

Methods

A retrospective propensity score–matched cohort study was conducted using a multi-institutional electronic medical record database. Adult patients undergoing single- or multi-level TLIF between 2004 and 2024 were identified using CPT codes 22,633 and 22,634. The exposure group included patients prescribed SSRIs/SNRIs within two years before surgery. Exclusion criteria included infection, malignancy, inflammatory bone disease, prior lumbar fusion, and documented pseudoarthrosis. Matching (1:1) was performed across demographics and > 300 comorbidities. Outcomes were assessed at 30, 90 days, and 2-, and 5-year intervals using chi-squared tests and t-tests.

Results

After propensity matching, 14,536 patients undergoing single-level TLIF and 4,386 patients undergoing multi-level TLIF were included. At 30 days, SSRI/SNRI use was associated with significantly higher rates of infection and opioid utilization in both cohorts. At 90 days, SSRI/SNRI use was associated with higher rates of pneumonia, incision and drainage, and opioid utilization in single-level TLIF. Among multi-level TLIF, SSRI/SNRI use was associated with increased opioid and emergency department utilization. At two years, SSRI/SNRI use was associated with higher rates of pseudoarthrosis and adjacent segment disease following single-level TLIF. Among multi-level TLIF, SSRI/SNRI use was associated with higher rates of reoperation at five years.

Conclusion

Preoperative SSRI/SNRI use was independently associated with increased short- and long-term complications following TLIF, underscoring the importance of incorporating antidepressant exposure into perioperative risk assessment.