Introduction: Patients with pre-existing psychiatric diagnoses have been reported to have suboptimal post operative outcomes in various surgical fields, however, few such studies exist in the orthopaedic surgery literature. The goal of this study was to examine the affect a pre-operative psychiatric diagnosis had on short-term post-operative outcomes in patients undergoing surgical fixation of a pelvic fracture.

Methods: The American College of Surgeons – Trauma Quality Improvement Program (TQIP) was queried using ICD10 procedure codes to identify patients undergoing operative fixation of a pelvic fracture from 2017-2021. The patient cohort was stratified into two groups, those with a pre-existing psychiatric diagnosis versus those without a pre-existing psychiatric diagnosis. Psychiatric diagnoses included in the TQIP variable were schizophrenia, bipolar disorder, major depressive disorder, social anxiety disorder, posttraumatic stress disorder, and antisocial personality disorder. Our primary outcome measure was pooled infection rate. Secondary outcome measures included infections that comprised the pooled infection variable, as well as other post-operative sequela captured in the TQIP database. Outcome measures between the two cohorts were compared using chi-square and Fisher’s exact test.

Results: A total of 107,748 patients undergoing pelvic fixation were identified, as well as 11,306 with a mental health/personality disorder at time of admission. Patients with pre-existing psychiatric diagnoses were more likely to also have comorbid conditions than those without a pre-existing psychiatric diagnosis. Furthermore, these patients were more likely to have a positive drug screen on admission compared to those without a pre-existing psychiatric diagnosis. In terms of overall infection, individuals with a pre-existing psychiatric diagnosis were more likely to experience infection overall, as well as dSSI, sSSI, organ space infection and osteomyelitis, compared to those without a psychiatric history (p<0.05).

Conclusions: Patients with pre-existing psychiatric diagnoses represent a unique and significant portion of patients undergoing pelvic fracture surgery. These patients are more likely to suffer from substance misuse and comorbid conditions at time of admission, thus requiring increased attention and optimization both before and following surgery to help mitigate risk of post-operative complications.