{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:20Z","timestamp":1787840540137,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"\n Context:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Aims:<\/jats:title>\n The aims of this study were to quantify the prevalence of these disorders and evaluate associations with perioperative outcomes and resource use.<\/jats:p>\n <\/jats:sec>\n \n Settings and Design:<\/jats:title>\n This was a retrospective cohort study using the National Inpatient Sample from 2016 to 2022.<\/jats:p>\n <\/jats:sec>\n \n Subjects and Methods:<\/jats:title>\n Depression and psychotic disorders were defined using Elixhauser-derived indicators. Outcomes included medical and mechanical complications, discharge disposition, length of stay (LOS), and costs.<\/jats:p>\n <\/jats:sec>\n \n Statistical Analysis Used:<\/jats:title>\n \n Chi-square and logistic regression analyses were performed, with significance at the\n P<\/jats:italic>\n < 0.05 level.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 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,\n P<\/jats:italic>\n < 0.001), mechanical complications (OR: 1.29,\n P<\/jats:italic>\n < 0.001), and nonhome discharge (OR: 1.21,\n P<\/jats:italic>\n < 0.001). Psychoses were associated with higher odds of cardiovascular complications (OR: 1.26,\n P<\/jats:italic>\n < 0.001), mechanical complications (OR: 1.59,\n P<\/jats:italic>\n < 0.001), and nonhome discharge (OR: 1.49,\n P<\/jats:italic>\n < 0.001). Compared with depression, psychoses had higher odds of mechanical complications (OR: 1.21,\n P<\/jats:italic>\n = 0.016) and nonhome discharge (OR: 1.27,\n P<\/jats:italic>\n < 0.001). The mean LOS increased stepwise (4.3 vs. 4.7 vs. 5.1 days;\n P<\/jats:italic>\n < 0.001), and costs were higher ($53,200 vs. $55,400 vs. $57,900;\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Depression and psychotic disorders are common among patients undergoing multilevel lumbar fusion and are associated with higher healthcare utilization.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jcvjs.jcvjs_214_25","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T13:00:09Z","timestamp":1773838809000},"page":"138-144","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Depression and psychotic disorders worsen perioperative outcomes and increase resource utilization after multilevel lumbar fusion: Implications for screening and perioperative care"],"prefix":"10.4103","volume":"17","author":[{"given":"Leonidas E.","family":"Mastrokostas","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA"},{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G.","family":"Mastrokostas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA"},{"name":"Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke B.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Razi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic 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