Steven Schwartz1, Shahrzad Bazargan-Hejazi2, Deyu Pan3, David Ruiz4, Anaheed Shirazi5, Eleby Washington6. 1. Assistant Professor of Orthopedic Surgery at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles. stevenschwartz@cdrewu.edu. 2. Professor at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles. shahrzadbazargan@cdrewu.edu. 3. is an Instructor at the Charles R Drew University of Medicine and Science in Los Angeles, CA. deyupan@cdrewu.edu. 4. Interventional Radiologist at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles. druiz@g.ucla.edu. 5. Research Intern at the Charles R Drew University of Medicine and Science in Los Angeles, CA. anaheed.shirazi@gmail.com. 6. Professor of Orthopedic Surgery at the Charles R Drew University of Medicine and Science and at the David Geffen School of Medicine at the University of California, Los Angeles, and an Orthopedic Surgeon at the Martin Luther King, Jr Outpatient Center and Community Hospital. elebywashington@cdrewu.edu.
Abstract
CONTEXT: Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. OBJECTIVE: To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. DESIGN: Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years. From the injury data, we extracted psychiatric diagnoses, alcoholism, substance abuse, and sociodemographic characteristics. MAIN OUTCOME MEASURES: Length of stay, surgical complications, and inpatient deaths. RESULTS: The entire injury admissions represented about 1.9% of all hospital admissions and were predominantly older than age 64 years, white, and women with conventional health care insurance. The most common comorbidity in the patients with injury was psychiatric illness (24.7%). The most common psychiatric diagnoses in orthopedic injury admissions were dementia (14.3%) and depression (6.9%) without association. Compared with the injury admissions with no psychiatric diagnosis, admissions with psychiatric diagnosis had higher odds of a hospital stay of 7 or more days, surgical treatment complications, and inhospital death. CONCLUSION: Psychiatric comorbidity adversely affects several hospital outcomes in patients with orthopedic injuries: Length of stay, surgical complications, and inpatient mortality. In low-income populations, the adverse psychiatric effects are incrementally worse. The adverse effects of psychiatric comorbidity, particularly dementia and depression, on hospital outcomes should stimulate improved psychiatric care of many patients at risk of poor clinical outcomes.
CONTEXT: Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. OBJECTIVE: To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. DESIGN: Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years. From the injury data, we extracted psychiatric diagnoses, alcoholism, substance abuse, and sociodemographic characteristics. MAIN OUTCOME MEASURES: Length of stay, surgical complications, and inpatient deaths. RESULTS: The entire injury admissions represented about 1.9% of all hospital admissions and were predominantly older than age 64 years, white, and women with conventional health care insurance. The most common comorbidity in the patients with injury was psychiatric illness (24.7%). The most common psychiatric diagnoses in orthopedic injury admissions were dementia (14.3%) and depression (6.9%) without association. Compared with the injury admissions with no psychiatric diagnosis, admissions with psychiatric diagnosis had higher odds of a hospital stay of 7 or more days, surgical treatment complications, and inhospital death. CONCLUSION:Psychiatric comorbidity adversely affects several hospital outcomes in patients with orthopedic injuries: Length of stay, surgical complications, and inpatient mortality. In low-income populations, the adverse psychiatric effects are incrementally worse. The adverse effects of psychiatric comorbidity, particularly dementia and depression, on hospital outcomes should stimulate improved psychiatric care of many patients at risk of poor clinical outcomes.
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