Preexisting psychiatric illness worsens acute care outcomes after orthopaedic trauma in obese patients |
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| Affiliation: | 1. Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, 32611, USA;2. Anesthesia, University of Florida, Gainesville, FL, 32611, USA;3. Clinical Psychology, University of Florida, Gainesville, FL, 32611, USA;1. Trauma and Orthopaedic Registrar, Northern Deanery, United Kingdom;2. Trauma and Orthopaedic Core Surgical Trainee, North West Deanery, United Kingdom;3. Paediatric Trauma and Orthopaedic Consultant, Alder Hey Children’s Hospital, United Kingdom;4. Trauma and Orthopaedic Registrar, North West Deanery, United Kingdom;1. University Medical Centre Hamburg-Eppendorf, Hamburg, Germany;2. Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom;3. Department of Orthopaedics, University of Edinburgh, Scotland, United Kingdom;1. Manchester University, Oxford Rd, Manchester, M13 9PL, UK;2. Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Academia & Research), Medical Directorate, ICT Centre, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK;3. Royal Stoke University Hospital, University Hospital North Midlands, Stoke on Trent, Staffordshire, ST4 6QG, UK;4. Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK;5. Emergency Department, Derriford Hospital, Plymouth, PL6 8DH, UK;1. Department of Orthopaedics, Walter Reed National Military Medical Center, United States;2. Department of Orthopaedics and Podiatry, US Naval Hospital Okinawa, Camp Foster, FPO, United States |
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| Abstract: | PurposePre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopaedic 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 = 6353). 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 (<30 kg/m2 [non-obese], 30–39.9 kg/m2 [obese] and ≥40 kg/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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| Keywords: | Obesity Body mass index Trauma Psychiatric illness Outcomes Alcohol abuse Illicit drug Length of stay Mortality Postacute care |
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