Risk of Fracture and Complications Following Fixation in Patients with Pre-injury Psychiatric Illness: A Propensity-Matched Cohort Study

Abstract

OBJECTIVE: The purpose was to describe the frequency of orthopaedic trauma and post-surgical complications associated with psychiatric diagnoses. METHODS: Design: Query of TriNetx Analytics Network Setting: Participating hospitals Patient selection criteria: Those ≥ 18 years old with psychiatric illness and orthopaedic trauma Outcome measures and comparisons: Fractures and post-operative complications were described. A 1:1 propensity score matching function was utilized. Odds ratios compared inter-cohort complications. RESULTS: A total of 11,266,415 patients were identified with a psychiatric diagnosis, including bipolar disorder (8.9%), schizophrenia (3.3%), major depression (12.4%), stress-related disorder (9.6%), anxiety disorder (64.5%), borderline personality disorder (BPD) (1.1%), or antisocial personality (0.2%). Prevalence of 30.2% was found for a fracture and at least one psychiatric diagnosis. Antisocial personality disorder had the highest risk ratio relative to people without that mental disorder (RR = 5.09) of having one or more associated fracture, followed by depression (RR = 3.03), stress-related disorders (RR = 3.00), anxiety disorders (RR = 2.97), BPD (RR = 2.92), bipolar disorder (RR = 2.80), and schizophrenia (RR = 2.69). Patients with at least one psychiatric comorbidity had greater risk of pulmonary embolism, superficial and deep surgical site infections, pneumonia, urinary tract infection, deep venous thrombosis, osteonecrosis, and complex regional pain syndrome by 1 month after fixation, when compared with patients without psychiatric disorder. By 1 year, they were also at an increased risk for stroke and myocardial infarction. CONCLUSIONS: All psychiatric comorbidities were associated with increased relative risk of fracture and higher odds of complications compared with patients without psychiatric comorbidities. Providers should be aware of pre-existing psychiatric diagnoses during treatment of acute injuries due to these risks. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.