Antipsychotic Medications are Associated with Higher Rates of Healthcare Utilization, Complications, Opioid Prescriptions, and Subsequent Cervical Surgery after Anterior Cervical Discectomy and Fusion.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To evaluate the impact of pre-operative antipsychotic medication (APM) exposure on healthcare utilization, complications, opioid prescriptions, and subsequent cervical surgery following anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA: While psychiatric disorders have been linked to poorer outcomes after ACDF, the impact of psychotropics, like APMs, remains unclear. This is important considering 40.4% of patients with mental disorders receive pharmacologic treatments, many of which are also used for off-label purposes. Moreover, APMs have antagonistic effects on histamine, muscarinic, dopamine, and alpha-adrenergic receptors, leading to systemic physiologic changes that may affect peri-operative recovery and outcomes.

METHODS

The TriNetX database was queried to identify patients over 18 years old who underwent primary ACDF. Patients were stratified into two cohorts based on APM prescription within six months prior to surgery. Cohorts underwent propensity score matching in a 1:1 ratio based on 45 covariates. The following outcomes were collected: 1) medical complications and healthcare utilization within three months, 2) opioid prescriptions within two years, and 3) surgical complications and subsequent surgery within two years.

RESULTS

Within three months, APM exposure was associated with higher rates of readmission (P<0.001) and emergency department visits (P<0.001). APM exposure was also associated with higher rates of medical complications, including venous thromboembolism (P<0.001) and dysphagia (P<0.001). Patients in the APM group received a greater number of opioid prescriptions at all time points within two years, accumulating nearly 45% more prescriptions than controls by two-year follow-up (9.9 vs. 6.9 mean prescriptions, P<0.001). Lastly, APM exposure was associated with higher rates of subsequent cervical fusion (P=0.006) and subsequent cervical surgery (P=0.010) at two-year follow-up.

CONCLUSION

APM exposure is associated with greater healthcare utilization, medical morbidity, opioid prescriptions, and subsequent cervical surgery after ACDF. These risks may be mitigated through opioid stewardship, multi-disciplinary collaboration, and targeted patient counseling.

LEVEL OF EVIDENCE: IV.