Impact of Antidepressant Use on Intraoperative Blood Loss and Transfusion Rates in Lumbar Fusion Surgery

OBJECTIVE: A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery. The purpose of this study is to investigate the impact of antidepressants on intraoperative bleeding risk during lumbar fusion. METHODS: Patients who underwent elective 1-3 level lumbar fusion at a single, academic, tertiary center (2017-2021) were identified. Antidepressant use and class, demographic, and surgical data were evaluated. Bleeding risk was assessed by total intraoperative blood loss (mL), calculated using the formula by Gross et al., and by postoperative transfusion. Patients prescribed versus not prescribed an antidepressant were matched 1:1 by age, sex, body mass index, Elixhauser, smoking status, and levels fused. Appropriate statistical analysis was performed (alpha was set at 0.05). RESULTS: A total of 420 patients with and 420 patients without an antidepressant prescription at the time of lumbar fusion were identified. Patients without an antidepressant prescription had a higher Charlson Comorbidity Index (0.91 ± 1.09 vs. 0.76 ± 1.1; P = 0.048), but otherwise the groups were demographically similar, and underwent similar surgeries. Antidepressant use was not associated with increased intraoperative bleeding or postoperative transfusion rate, regardless of subanalysis by procedure type or antidepressant class. CONCLUSIONS: Antidepressant use was not associated with increased intraoperative blood loss or increased postoperative transfusion requirement, regardless of subanalysis by fusion type or antidepressant class. The current findings do not support discontinuing antidepressants prior to lumbar fusion.