Psychiatric Diagnosis Does Not Influence Management or Resolution of Confirmed Fracture-Related Infection

The purpose of this study was to determine if the presence of a standing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, psychiatric diagnosis is associated with worse outcomes for patients who develop a confirmed fracture-related infection (FRI).

Included patients had open or closed fractures managed with internal fixation and had confirmed FRIs. Baseline demographics, injury information, and outcomes were collected via chart review. All patients who had a diagnosis of psychiatric illness, which included depression, bipolar disorder, anxiety disorder, and schizophrenia, were identified. Patients with and without a psychiatric diagnosis were statistically compared.

Two hundred eleven patients were diagnosed with a confirmed FRI. Fifty-seven (27.0%) patients had a diagnosis of a psychiatric illness at the time of FRI diagnosis. Patients with a psychiatric diagnosis had a higher rate of smoking (56% vs 40%, P=.039) and drug use (39% vs 19%, P=.004) and a higher American Society of Anesthesiologists (ASA) classification (2.35±1.33 vs 1.96±1.22, P=.038); however, there were no other demographic differences. Clinical outcomes also did not differ between the groups, as patients with an FRI and a psychiatric diagnosis had a similar time to FRI diagnosis, similar confirmatory FRI characteristics, and a similar rate of reoperation. Furthermore, there was no difference between patients with FRI with and without a psychiatric diagnosis regarding rate of infection resolution (89% vs 88%, P=.718) or time to final follow-up (20.13±24.93 vs 18.11±21.81 months, P=.270).

The presence of a psychiatric diagnosis does not affect clinical outcomes in the patient population with FRI. This is the first study exploring the impact of psychiatric illness on patient outcomes after a confirmed FRI diagnosis. [Orthopedics. 2024;47(4):198-204.].