Prevalence of mood-altering and opioid medication use among spine surgery candidates and relationship with hospital cost.

Depression is the most common psychiatric illness in the USA and is commonly diagnosed in patients with chronic back pain. We investigated the use of mood-altering medications among spine surgery candidates and the relationship with opioid use and cost of care. We retrospectively reviewed the charts of 578 spine surgery patients who underwent surgery during 2005 to 2007 and their hospital charges. Patients were divided by type of spine surgery as follows: 154 lumbar microdiscectomies (LMD), 297 anterior cervical decompression and fusions (ACDF) and 127 lumbar decompression and fusions (LDF). We found that 25.4% of spine surgery candidates were on antidepressants, 9.3% on anxiolytics, and 41.3% on opioids were. More precisely, 26.6% of LMD, 24.6% of ACDF and 26% of LDF patients were on antidepressants; 9.1% of LMD, 7.1% of ACDF, and 15% of LDF patients were on anxiolytics; and 47.4% of LMD, 36% of ACDF, and 46.5% of LDF patients were on opioids. Of all patients, 16.8% were on two or three types of these medications. Significantly more antidepressants were used by females in the ACDF and LDF groups and more opioids were used by African Americans in the LDF group. There were significant differences (p<0.05) in the length of stay and hospital cost between patients on antidepressants and those not on antidepressants in the LDF group, especially among females. Opioids are the most commonly used psychoactive drugs among chronic back pain and spine surgery candidates followed by antidepressants and anxiolytics. Screening for antidepressant use among spine surgery patients seems reasonable on the preoperative visit. This would help adjust antidepressant medications following surgery as depression might resolve in response to pain improvement. If antidepressant medications were initially prescribed to treat pain; they also might need to be tapered off postoperatively to correspond with new pain levels. The relationship of antidepressants with increased hospital charges in this category of patients requires further investigation.