European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Impact of mental health disorders and perioperative outcomes following anterior cervical discectomy and fusion (ACDF): a national inpatient analysis.
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Ng Mitchell, Mastrokostas Leonidas, Mastrokostas Paul, Baek Gregorio, Dalton Jonathan, Fano Adam, Giakas Alec, Singh Rajendra, Razi Afshin, Varthi Arya, Kurd Mark, Wilt Zachary, Fassett Daniel, Hilibrand Alan, Vaccaro Alexander, Schroeder Gregory, Kepler Christopher, Alvarez Andrew
Аннотация
PURPOSE: Mental health disorders have been shown to influence surgical outcomes, yet their effects on cervical spine surgery remain incompletely defined. This study evaluated the impact of depression and psychotic disorders on (1) perioperative complications, (2) discharge disposition, and (3) hospital resource utilization following anterior cervical discectomy and fusion (ACDF).
METHODS: The National Inpatient Sample (NIS) was queried for adult ACDF admissions from 2016 to 2022. Patients were classified into those with either no mental illness, depression, or psychotic disorder. Medical/surgical complications, dysphagia, and overall adverse events were extracted using ICD-10 diagnosis codes. Discharge status, inpatient mortality, costs, and length of stay were also evaluated across all cohorts. Subsequent analyses were adjusted for demographics, Elixhauser comorbidity index, hospital characteristics, and levels fused. Fusion level was included as a categorical covariate (single-level vs. multilevel) in all adjusted regression models. Multivariable logistic regression estimated adjusted odds ratios for complications/discharge outcomes, while weighted linear models compared/contrasted healthcare utilization with statistical significance set at P < 0.05.
RESULTS: 376,130 inpatient ACDFs were identified (64,020 with depression, 11,255 with psychotic disorders). Depression was associated with increased cardiovascular complications (OR 1.28, 95% CI 1.16-1.41), dysphagia (OR 1.09, 95% CI 1.02-1.18), and non-routine discharge (OR 1.15, 95% CI 1.09-1.21). Psychotic disorders were associated with increased rates of cardiovascular events (OR 1.29, 95% CI 1.04-1.59), mechanical complications (OR 1.36, 95% CI 1.01-1.83), and non-routine discharge (OR 1.47, 95% CI 1.32-1.64). Both mean costs and length of stay were likewise higher in patients with mental disorders (P < 0.001).
CONCLUSION: Mental health disorders are associated with increased postoperative complications, non-routine discharge, and healthcare utilization following ACDF. Appropriate diagnosis, management, and preoperative optimization may improve outcomes in this patient population.
METHODS: The National Inpatient Sample (NIS) was queried for adult ACDF admissions from 2016 to 2022. Patients were classified into those with either no mental illness, depression, or psychotic disorder. Medical/surgical complications, dysphagia, and overall adverse events were extracted using ICD-10 diagnosis codes. Discharge status, inpatient mortality, costs, and length of stay were also evaluated across all cohorts. Subsequent analyses were adjusted for demographics, Elixhauser comorbidity index, hospital characteristics, and levels fused. Fusion level was included as a categorical covariate (single-level vs. multilevel) in all adjusted regression models. Multivariable logistic regression estimated adjusted odds ratios for complications/discharge outcomes, while weighted linear models compared/contrasted healthcare utilization with statistical significance set at P < 0.05.
RESULTS: 376,130 inpatient ACDFs were identified (64,020 with depression, 11,255 with psychotic disorders). Depression was associated with increased cardiovascular complications (OR 1.28, 95% CI 1.16-1.41), dysphagia (OR 1.09, 95% CI 1.02-1.18), and non-routine discharge (OR 1.15, 95% CI 1.09-1.21). Psychotic disorders were associated with increased rates of cardiovascular events (OR 1.29, 95% CI 1.04-1.59), mechanical complications (OR 1.36, 95% CI 1.01-1.83), and non-routine discharge (OR 1.47, 95% CI 1.32-1.64). Both mean costs and length of stay were likewise higher in patients with mental disorders (P < 0.001).
CONCLUSION: Mental health disorders are associated with increased postoperative complications, non-routine discharge, and healthcare utilization following ACDF. Appropriate diagnosis, management, and preoperative optimization may improve outcomes in this patient population.