The mental stigma: Influence of psychiatric comorbidity on treatment timelines and discharge processes in patients with pelvic injuries.

Abstract

Individuals with psychiatric disorders and substance use are at greater risk of sustaining severe injuries due to behavioral impulsivity, impaired judgment, and medication effects. The influence of psychiatric comorbidities on the hospitalization of patients with pelvic fractures remains underexplored. This study investigates the impact of psychiatric disorders and substance abuse on hospitalization outcomes for these patients. This retrospective, single-center cohort study was conducted from 2014 to 2023, including patients aged ≥ 18 years with high-energy pelvic and acetabular fractures and documented psychiatric disorders or substance abuse history. Exclusion criteria included subjects with incomplete or missing data, pathological pelvic fractures, patients younger than 18 years, non-trauma admissions, conservative fractures. Patients were divided into two groups: the mental group (with psychiatric comorbidities and/or substance abuse) and the control group. We analyzed factors such as emergency department length of stay, Injury-to-surgery interval, surgery-to-discharge readiness interval, discharge readiness-to-discharge interval and the necessity of discharge support service. A total of 208 patients were included, of whom 22 (10.6%) had psychiatric comorbidities. Patients with psychiatric disorders were significantly younger and had more severe injuries than control group. Despite a shorter injury-to-surgery interval (3.5 vs. 6.1 days, p = 0.007), psychiatric patients had significantly longer hospital stays (44.7 vs. 18.5 days, p = 0.050). There was no significant difference in the surgery-to discharge readiness interval, but psychiatric patients experiencing a prolonged discharge readiness-to-discharge interval (19.2 vs. 3.4 days, p = 0.032). Psychiatric comorbidities significantly influence hospitalization dynamics in pelvic fracture patients. Although psychiatric patients undergo surgery more quickly and achieved clinical recovery at similar times, compared to controls, their hospital stays are prolonged due to psycho-social and organizational barriers rather than ongoing medical needs. A higher proportion of psychiatric patients required discharge support services, emphasizing the role of non-medical factors in discharge delays. Our findings indicate that the higher proportion of patients in the mental health group requiring discharge support services suggests that non-medical factors are major contributors to discharge delays. The higher rate of discharge-support activation further confirms the greater dependence of this population on structured continuity-of-care pathways.