Document Type
Article
Publication Date
3-18-2026
Abstract
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.
Recommended Citation
Mastrokostas, Leonidas E.; Mastrokostas, Paul G.; Schwartz, Luke B.; Razi, Abigail; Inzerillo, Sean; Houten, John K.; Varthi, Arya; Vaccaro, Alex R.; Monsef, Jad Bou; Razi, Afshin E.; and Ng, Mitchell K., "Depression and Psychotic Disorders Worsen Perioperative Outcomes and Increase Resource Utilization After Multilevel Lumbar Fusion: Implications for Screening and Perioperative Care" (2026). Rothman Institute Papers. Paper 321.
https://jdc.jefferson.edu/rothman_institute/321
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Language
English
Comments
This article is the author’s final published version in Journal of Craniovertebral Junction and Spine, Volume 17, Issue 2, 2026, pages 138-144.
The published version is available at https://doi.org/10.4103/jcvjs.jcvjs_214_25. Copyright © 2026 Journal of Craniovertebral Junction and Spine.