Depression and psychotic disorders elevate inpatient burden after posterior cervical decompression and fusion: Prioritizing screening and targeted discharge planning

Context: Psychiatric comorbidity has been associated with worse perioperative outcomes and greater healthcare utilization after spine surgery. Aims: This study compared complications and healthcare utilization among posterior cervical decompression and fusion (PCDF) patients with depression, psychotic disorders, or no mental-health diagnosis. Settings and Design: Retrospective cohort analysis of the National Inpatient Sample from 2016 to 2022. Materials and Methods: 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. Statistical Analysis Used: Chi-square and multivariate logistic regression analyses were performed. Significance was set at the P < 0.05 level. Results: 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). Conclusions: Depression and psychotic disorders are common in PCDF and are linked to worse outcomes and higher resource use.