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The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures


Affiliations
1 University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States
2 Johns Hopkins Department of Orthopaedic Surgery, 1800 Orleans Street, Baltimore, MD 21287, United States
 

Background: The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods: The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results: A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P < 0.001). Depression was associated with higher odds of inpatient blood transfusion (P < 0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P < 0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P < 0.001) more days of care than patients with no psychiatric comorbidity. Discussion: Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.
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  • The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures

Abstract Views: 74  |  PDF Views: 8

Authors

Leonard T. Buller
University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States
Matthew J. Best
Johns Hopkins Department of Orthopaedic Surgery, 1800 Orleans Street, Baltimore, MD 21287, United States
Milad Alam
University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States
Karim Sabeh
University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States
Charles Lawrie
University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States
Stephen M. Quinnan
University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1400 NW 12th Avenue, Miami, FL 33136, United States

Abstract


Background: The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods: The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results: A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P < 0.001). Depression was associated with higher odds of inpatient blood transfusion (P < 0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P < 0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P < 0.001) more days of care than patients with no psychiatric comorbidity. Discussion: Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.