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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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"Throwing the Flag": Patient Behavior Reporting Affects Outcomes After Orthopaedic Trauma Surgery.

Nathaniel P Mercer¹, Alexander J Egol, Sophia Jacobi

¹NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma, NYU Langone Health, New York, NY.

Journal of Orthopaedic Trauma

|March 9, 2026

Summary

Electronic health record (EHR) behavioral flags in orthopedic trauma patients are linked to increased major complications and reoperations after fracture fixation. Preoperative flags show the strongest association with adverse outcomes, indicating elevated perioperative risk.

Keywords:

behavioral flags postoperative complications propensity score matching reoperation

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Area of Science:

Orthopedic Surgery
Trauma Care
Health Informatics

Background:

Electronic Health Records (EHRs) increasingly incorporate behavioral flags to document patient conduct.
The impact of these flags on surgical outcomes, particularly in orthopedic trauma, remains under-investigated.

Purpose of the Study:

To assess the association between EHR-based behavioral flag designation and postoperative outcomes in orthopedic trauma patients.
To determine if preoperative behavioral flags are associated with a higher risk of adverse surgical outcomes.

Main Methods:

Retrospective cohort study utilizing 1:1 propensity score matching.
Inclusion of adult orthopedic trauma patients undergoing operative fixation for acute fractures.
Analysis of 1-year rates of major postoperative complications and reoperations.

Main Results:

Patients with behavioral flags had significantly higher odds of major complications (OR 5.57) and reoperation (OR 4.06) compared to unflagged controls.
Preoperative behavioral flags were associated with the highest odds of major complications (OR 14.74).
Adequate covariate balance was achieved post-matching, with a median follow-up of 12 months.

Conclusions:

EHR behavioral flag designation is associated with increased major postoperative complications and reoperations in orthopedic trauma.
Preoperative behavioral flags are a strong indicator of elevated perioperative risk.
Behavioral flags may serve as a valuable marker for identifying patients at higher risk for adverse outcomes.