Depression and psychotic disorders worsen perioperative outcomes and increase resource utilization after multilevel lumbar fusion: Implications for screening and perioperative care.

CONTEXT: Multilevel lumbar fusion use has increased with an aging U.S. population. Depression and psychotic disorders are linked to poorer surgical outcomes, but their effects in this setting are unclear.

AIMS: The aims of this study were to quantify the prevalence of these disorders and evaluate associations with perioperative outcomes and resource use.

SETTINGS AND

DESIGN

This was a retrospective cohort study using the National Inpatient Sample from 2016 to 2022.

SUBJECTS AND

METHODS

Depression and psychotic disorders were defined using Elixhauser-derived indicators. Outcomes included medical and mechanical complications, discharge disposition, length of stay (LOS), and costs.

STATISTICAL ANALYSIS USED: Chi-square and logistic regression analyses were performed, with significance at the P < 0.05 level.

RESULTS

Among 458,180 weighted admissions, 18.6% had depression and 2.5% had psychoses. Compared to patients without these diagnoses, depression was associated with higher odds of cardiovascular complications (odds ratio [OR]: 1.25, P < 0.001), mechanical complications (OR: 1.29, P < 0.001), and nonhome discharge (OR: 1.21, P < 0.001). Psychoses were associated with higher odds of cardiovascular complications (OR: 1.26, P < 0.001), mechanical complications (OR: 1.59, P < 0.001), and nonhome discharge (OR: 1.49, P < 0.001). Compared with depression, psychoses had higher odds of mechanical complications (OR: 1.21, P = 0.016) and nonhome discharge (OR: 1.27, P < 0.001). The mean LOS increased stepwise (4.3 vs. 4.7 vs. 5.1 days; P < 0.001), and costs were higher ($53,200 vs. $55,400 vs. $57,900; P < 0.001).

CONCLUSIONS

Depression and psychotic disorders are common among patients undergoing multilevel lumbar fusion and are associated with higher healthcare utilization.