Psychiatric diagnosis not associated with worse outcomes after fracture-related infection
Key takeaways:
- Patients with vs. without psychiatric diagnoses had similar clinical outcomes after fracture-related infection.
- Psychiatric diagnoses included depression, bipolar disorder, anxiety disorder and schizophrenia.
According to results published in Orthopedics, patients with vs. without psychiatric diagnoses, such as depression, bipolar disorder, anxiety disorder and schizophrenia, had similar clinical outcomes after fracture-related infection.
Researchers performed a study of 211 patients who had a confirmed infection after undergoing internal fixation of an open or closed fracture between Jan. 1, 2010, and June 1, 2022.
Among the cohort, 57 patients (27%) had a psychiatric diagnosis, such as depression, bipolar disorder, anxiety disorder or schizophrenia at the time of infection. Researchers compared outcomes between patients with a psychiatric diagnosis vs. patients without a psychiatric diagnosis.
After retrospective chart review, researchers found patients with a psychiatric diagnosis had higher rates of smoking (56% vs. 40%) and drug use (39% vs. 19%), as well as a higher American Society of Anesthesiologists classification (2.35 vs. 1.96) compared to patients without a psychiatric diagnosis.
Overall, patients with a psychiatric diagnosis had similar time to infection diagnosis, characteristics for confirmation of infection and rate of reoperation vs. patients without a psychiatric diagnosis. In addition, researchers found patients with a psychiatric diagnosis had a similar rate of infection resolution (89% vs. 88%) and time to final follow-up (20.13 vs. 18.11 months) compared to patients without a psychiatric diagnosis.
“Despite the known association of psychiatric disorders with poor clinical outcomes, this analysis demonstrated no difference in infection resolution to date between patients with fracture-related infection with and without a psychiatric diagnosis,” the researchers wrote in the study.
Perspective
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The article "Psychiatric diagnosis does not influence management or resolution of confirmed fracture related infection" by Nina D. Fisher, MD, and colleagues found that patients who have a fracture-related infection have similar demographics, infections and outcomes compared with patients with and those without a psychiatric diagnosis. Psychiatric diagnoses are a known risk factor for poor outcomes in many conditions, including open tibia fractures, with an increased risk for infection and wound complications.
It is impressive that 27% of patients who developed a fracture-related infection had a psychiatric diagnosis in this large retrospective series of more than 200 patients. Despite patients with a psychiatric diagnosis having a higher American Society of Anesthesiologists classification, and higher rates of cigarette and drug use than patients without a diagnosis, outcomes of re-infection and duration of follow-up are nearly identical. With complications of fracture-related infection or recalcitrant infection, nonunion and amputation being relatively high in orthopedic trauma injuries and the high (27%) incidence of psychiatric diagnoses in their patient population, it is unlikely that a statistical signal was “missed,” which could be true in total joint infections, which are less than 1%, and/or if a condition is rarer.
The authors are also to be commended that there is no apparent evidence of discrimination of patients with a psychiatric diagnosis given their high incidence of occurrence and their equivalent outcomes. I hope the authors could share how their physicians and system attained these laudable results.
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