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.
Highlights
Psychiatric comorbidity is associated with longer hospital stays, higher risk of suboptimal outcomes, and increased resource utilization among patients undergoing inpatient surgery [1,2,3,4,5,6,7]
While prior research in lower extremity fractures has demonstrated longer hospital stays, more in-hospital adverse events, and lower rates of discharge to home among patients with psychiatric comorbidity [17], there is a paucity of data on the influence of psychiatric illness on acute, inpatient outcomes among patients admitted with upper extremity fractures
This study sought to evaluate the influence of psychiatric illness on length of stay, mortality, in-hospital adverse events, requirement for blood transfusion, and nonroutine discharge to another inpatient facility among patients admitted with distal humerus fractures
Summary
Psychiatric comorbidity is associated with longer hospital stays, higher risk of suboptimal outcomes, and increased resource utilization among patients undergoing inpatient surgery [1,2,3,4,5,6,7]. This study sought to evaluate the influence of psychiatric illness on length of stay, mortality, in-hospital adverse events, requirement for blood transfusion, and nonroutine discharge to another inpatient facility among patients admitted with distal humerus fractures. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P < 0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P < 0.001). 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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