Depression and psychotic disorders elevate inpatient burden after posterior cervical decompression and fusion:...

Psychiatric comorbidity has been associated with worse perioperative outcomes and greater healthcare utilization after spine surgery.

This study compared complications and healthcare utilization among posterior cervical decompression and fusion (PCDF) patients with depression, psychotic disorders, or no mental-health diagnosis.

Retrospective cohort analysis of the National Inpatient Sample from 2016 to 2022.

The database was queried for elective adult PCDF encounters. Mental-health exposures were defined using Elixhauser indicators for depression and psychoses. Outcomes included medical complications, non-routine discharge, inpatient mortality, length of stay (LOS), and costs.

Chi-square and multivariate logistic regression analyses were performed. Significance was set at the P < 0.05 level.

We identified 167,480 weighted admissions: 129,205 with no mental-health diagnosis, 32,500 with depression, and 5,775 with psychotic disorders. Depression was associated with higher odds of cardiovascular complications (odds ratio [OR]: 1.20, P < 0.001), mechanical complications (OR: 1.24, P < 0.001), a composite adverse-event outcome (OR: 1.17, P < 0.001), and nonroutine discharge (OR: 1.12, P < 0.001). Psychotic disorders were associated with higher odds of mechanical complications (OR: 1.44, P = 0.002), nonroutine discharge (OR: 1.32, P < 0.001), and inpatient mortality (OR: 2.33, P = 0.043). Costs were higher with depression and highest with psychotic disorders ($39,564 vs. $40,787 vs. $42,362; P < 0.001). LOS was higher with depression and highest with psychotic disorders (4.10 vs. 4.36 vs. 4.81 days; P < 0.001).

Depression and psychotic disorders are common in PCDF and are linked to worse outcomes and higher resource use.