Functional Outcomes of Patients with Schizophrenia After Hip Fracture Surgery

Abstract

Background: Schizophrenia impairs a patient's self-care abilities, which are crucial after a hip fracture. Studies on the outcomes of patients with schizophrenia after a hip fracture are dated. This study aims to investigate the complication rates, 1-year mortality, and functional outcomes of surgically managed hip fractures in elderly patients with schizophrenia.Methods: This is a retrospective, single-institution cohort study based on a prospectively maintained registry of patients with hip fracture. In this study, 3,056 patients who were ‡60 years of age were treated under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Baseline demographic characteristics and the Modified Barthel Index (MBI) scores were obtained at admission and at 6 months and 1 year after the fracture. Complications from the fracture and the surgical procedure were recorded during a minimum follow-up period of 2 years. A matching process (based on age, sex, and the MBI at admission) of up to 6 patients without schizophrenia per 1 patient with schizophrenia was utilized to increase power. Differences in perioperative, 6-month, and 1-year outcomes were compared for significance among surgically managed patients with schizophrenia and patients without schizophrenia.Results: Thirty-eight patients with schizophrenia were compared with 170 geriatric patients without schizophrenia who underwent a surgical procedure for a hip fracture. Patients with schizophrenia were more likely to be institutionalized postoperatively (26.3% compared with 4.7%; p < 0.001). Patients with schizophrenia had poorer MBI scores at 12 months (76 compared with 90 points; p = 0.006). The 1-year mortality rate was comparable (p = 0.29) between patients with schizophrenia (5.7%) and those without schizophrenia (2.4%). Similar trends in MBI were observed in the conservatively managed group of patients.Conclusions: There was no increase in postoperative complications after a surgical procedure for a hip fracture in elderly patients with schizophrenia. The 1-year mortality after a surgical procedure for hip fracture is similar in both patients with schizophrenia and those without schizophrenia. Patients with schizophrenia and hip fracture who were surgically managed had poorer 1-year functional outcomes compared with patients without schizophrenia matched for age, sex, and MBI at admission. This information will be useful in shared decision-making discussions with patients and families.

Outcomes of Physiotherapy on Activities of Daily Living and Discharge to the Community in Psychiatric Long-term Care Ward Patients

“…People with schizophrenia are known to be at significantly increased risk of fractures 13) , and complex psychopharmacological treatment 14) and excessive bone mineral density loss 15) have been identified as contributing factors. Physiotherapy for femoral neck fractures yielded poorer 1-year functional outcomes in patients with schizophrenia than in patients without schizophrenia but caused no increase in postoperative complications and no difference in 1-year mortality 16) , indicating a certain effect of physical therapy. In addition, the longer the LOS, the less likely the patients were to be discharged at the end of physiotherapy (Table 1).…”

Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder

“…In addition, the PD and SZ/SAD cohorts had higher postsurgical mortality than most of the other diagnostic cohorts even though they both were within the range of the control cohorts. Both SZ/SAD and PD have been shown in independent studies to have higher frequencies of adverse surgical outcomes relative to control populations without these conditions (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49). Weighting of disability of schizophrenia (weight 0.399-0.894) and PD (weight 0.011-0.711) overlap (55).…”

“…The extant literature demonstrates increased morbidity (OR 0.9-15) and mortality (odds ratio, OR = 1.11-2.70) in patients with schizophrenia/schizoaffective disorder (SZ/SAD) compared to populations without mental illness in studies that included surgeries for breast cancer, appendectomy, acute coronary syndrome, total joint arthroplasty, and a large retrospective review of all major surgeries combined (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Similarly, subjects with PD also experienced increased frequencies of surgical adverse events compared to populations without PD, including more colorectal surgical morbidity (+44%), hip arthroplasty complications (+65%), major complications (OR = 1.74-2.98) and mortality (+0.5%-5.5%) for spinal surgery (44)(45)(46)(47)(48)(49).…”

Bringing orthogeriatric care for elderly patients with hip fractures to Asia

“… 5 In addition, orthogeriatric care models have been shown to reduce acute post-injury complications and intra-hospital mortality, even in traditionally vulnerable populations. 7 Despite these published benefits, it is important to recognise the challenges in implementation of orthogeriatric care models. Certainly, there appears to be an asymmetrical distribution of orthogeriatric care models worldwide, particularly in Asia.…”