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

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.