Preexisting Psychiatric Illness Worsens Acute Care Outcomes after Orthopaedic Trauma in Obese Patients

Publication date: Available online 12 December 2017
Source:Injury
Author(s): Heather K. Vincent, Terrie Vasilopoulos, Laura Ann Zdziarski, Kalia K. Sadasivan, Jennifer Hagen, Robert Guenther, JoAnna McClelland, MaryBeth Horodyski
PurposePre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopedic trauma injuries. Obesity is an independent factor associated with poorer clinical outcomes and discharge disposition, and higher hospital resource use. It is not known whether interactions exist between pre-existing illness, illicit drug use and obesity on acute trauma care outcomes.Patients and MethodsThis cohort study is from orthopaedic trauma patients prospectively measured over 10 years (N=6,353). Psychiatric illness, illicit drug use and alcohol were classified by presence or absence. Body mass index (BMI) was analyzed as both a continuous and categorical measure (<30kg/m² [non-obese], 30–39.9kg/m² [obese] and ≥40kg/m² [morbidly obese]). Main outcomes were the number of acute care services provided, length of stay (LOS), discharge home, hospital readmissions, and mortality in the hospital.ResultsStatistically significant BMI by pre-existing condition (psychiatric illness, illicit drug use) interactions existed for LOS and number of acute care services provided (β values 0.012–0.098; all p<0.05). The interaction between BMI and psychiatric illness was statistically significant for discharge to locations other than home (β=0.023; p=0.001).DiscussionObese patients with orthopaedic trauma, particularly with preexisting mental health conditions, will require more hospital resources and longer care than patients without psychiatric illness. Early identification of these patients through screening for psychiatric illness and history of illicit drug use at admission is imperative to mobilize the resources and provide psychosocial support to facilitate the recovery trajectory of affected obese patients.



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