The association of mental health disease with perioperative outcomes following femoral neck fractures

Erik Zachwieja, Alexander J. Butler, Luis C. Grau, Spencer Summers, Dustin Massel, Fabio Orozco, Victor H. Hernandez

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: Mental illness in the United States is a growing problem, leading to significant implications for those effected as well as direct and indirect costs to the health care system. The association between psychiatric comorbidity and increased risk of perioperative adverse events has previously been described following elective orthopedic surgery, however, there is a paucity of literature evaluating the correlation between mental health disease and outcomes in patients in an orthopedic trauma setting. Methods: Utilizing data from the US National Hospital Discharge Survey, all patients undergoing surgery for femoral neck fracture were identified between the years 1990 and 2007. The association of depression, anxiety, dementia and schizophrenia on surgical outcomes were then analyzed using univariate regression analysis. Results: A cohort of 2,432,931 patients was identified. All psychiatric comorbidities were associated with a lower rate of routine discharge home following surgery (p < 0.001). Schizophrenia was associated with increased odds of any adverse event (p < 0.001), acute post-operative mechanical complications (p < 0.001) and increased length of stay (p < 0.001). Discussion: Patients undergoing surgery for femoral neck fracture with comorbid psychiatric illness are at increased risk for non-routine discharge. Schizophrenia is independently associated with an increased risk for post-operative complications. An awareness of these risks should optimize preoperative multidisciplinary patient care planning so as to maximize patient outcome and minimize resource utilization.

Original languageEnglish (US)
Pages (from-to)S77-S83
JournalJournal of Clinical Orthopaedics and Trauma
StatePublished - Oct 2019


  • Anxiety
  • Complications
  • Dementia
  • Depression
  • Hip fracture
  • Outcomes
  • Schizophrenia

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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