Effect of Mental Health Conditions on Complications, Revision Rates and Readmission Rates Following Femoral Shaft, Tibial Shaft and Pilon Fracture

OBJECTIVES: To evaluate the effect of pre-existing mental health (MH) conditions on 90-day complication, 90-day readmission, and all-time revision surgical intervention rates following femoral, tibial, and pilon fractures. DESIGN: Data were collected using a commercially available database software for which Current Procedural Terminology codes were used to identify patients who underwent surgical treatment of tibial, femoral, or pilon fractures. These patients were then subdivided into those with and without pre-existing MH condition using International Classification of Disease, Ninth Edition codes. Ninety-day postoperative complications, revision surgery, and 90-day readmission rates were then compared between those with and without MH conditions. SETTING: National databases of 70 million combined patients from 2007 to 2015. PATIENTS/PARTICIPANTS: Humana and Medicare insured patients. INTERVENTION: Surgical treatment of tibial, femoral, and pilon fractures. MAIN OUTCOME MEASUREMENTS: Ninety-day readmission, 90-day complications, and all-time revision surgical intervention. RESULTS: The total number of patients for femoral, tibial, and pilon treatment, respectively, included 6207, 6253, and 5940 without MH conditions and 4879, 5247, and 2911 with MH conditions. Femoral, tibial, and pilon readmission rates, revision rates, and complication rates were significantly higher among patients with MH disorders in matched cohorts after controlling for medical comorbidities (P ≤ 0.05 for all). CONCLUSIONS: Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.