The worldwide incidence of mental illness seems to be on the rise—and along with it a widespread recognition that this “epidemic” should receive at least as much attention as other health conditions. At the same time, many societies have transitioned to noninstitutionalized care for patients with severe mental health diagnoses. This parallel phenomenon has resulted in more individuals with mental and emotional challenges being cared for by their families and communities.
Orthopaedic surgeons are often asked what the prognosis is for recovery in a patient with a substantive mental health diagnosis, but only a few scholarly attempts have been made to answer that question. In the May 5, 2021 issue of JBJS, Ng et al. provide meaningful data regarding the concomitant diagnosis of schizophrenia among patients in their early 70s who experienced a hip fracture. One-year post-treatment results from this cohort study showed no differences in mortality or surgical or medical complications between patients with and matched patients without schizophrenia. These good-news findings are largely indicative of the high level of care hip fracture patients receive in the authors’ institution, which includes close collaboration among surgeons, geriatrists, physical therapists, and psychiatric clinicians.
However, the 1-year functional outcomes, as measured with the Modified Barthel Index, were worse in the cohort with schizophrenia. I think this is probably related to the difficulty of encouraging patients to participate in standardized rehabilitation processes, challenges associated with self-care, and potentially less-than-optimal social support.
We certainly need more research into determining the best peri- and post-treatment care for orthopaedic patients with severe mental health issues. Ideally, future investigations of these questions will focus on interactions between mental health professionals and surgical and rehabilitation teams. It is my hope that this study by Ng et al. will stimulate that type of research.
Click here for a downloadable Infographic summarizing this study.
Marc Swiontkowski, MD