Journal of the Pediatric Orthopaedic Society of North America · 2026
Two-Year Cumulative Risk of Mental Health Disorders After Pediatric Orthopaedic Surgery: A Retrospective Cohort Study Comparing Procedure Types.
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Zhu Stanley, Nicholas Erin, Walsh Charlie X, Singh Anya, Singh Sanidhya, Whitney Daniel G, Stepanovich Matthew, Walick Kristina, Gornitzky Alex
Аннотация
BACKGROUND: Surgery can be psychologically challenging for pediatric patients and their families, yet the impact of pediatric orthopaedic surgery on the future development of mental health disorders (MHDs) is incompletely understood. The purpose of this study was to determine whether the rate of the 2-year cumulative risk of common MHDs differed by the type of pediatric orthopaedic procedure.
METHODS: All patients aged ≤18 years undergoing pediatric orthopaedic surgery at a single academic medical center over a 10-year period were retrospectively identified by Current Procedural Terminology codes. Patients were categorized into 5 cohorts based on procedure type: lower extremity, upper extremity, spine, general, or multiple procedures. MHD-coded health care encounters (mood, anxiety, and behavioral/emotional disorders) were identified using International Classification of Diseases 10th Revision (ICD-10) codes and were assessed at baseline (12 months before surgery) and in 6-month intervals for up to 2 years after surgery. Individuals were considered to have a positive MHD outcome if they had at least 1 encounter containing an ICD-10 code for 1 of the included MHD categories. As the MHD outcome was evaluated as a cumulative risk, evidence of having MHD (ie, "yes") was carried forward over the remaining intervals following the first interval of a positive MHD diagnosis. Risk ratios (RR) of MHDs were estimated for each interval using the presurgical period as the reference. The ratio of risk ratios (RRR), a difference-in-difference estimand, was estimated to assess differences in the 2-year rate of change in MHD risk across cohorts, adjusting for age, sex, surgery time, and the COVID-19 period.
RESULTS: A total of 2,825 patients were included. Cohorts included lower extremity (n = 1,300; mean age: 11.4 years), upper extremity (n = 816; 8.7), spine (n = 386; 13.4), general (n = 170; 12.3), and multiple procedures (n = 153; 9.9). Presurgical baseline MHD prevalence ranged from 13% (upper extremity) to 18% (spine). All cohorts demonstrated higher cumulative MHD-coded encounter prevalence over the 2-year follow-up period. Pairwise comparisons found no meaningful difference in the rate of change in MHD risk between groups from 0 to 24 months, except for the upper extremity cohort which had a blunted increased rate of change in MHD risk compared to the lower extremity and spine cohorts.
CONCLUSIONS: At a single academic medical center, there was a similar rate of MHD risk accumulation following different pediatric orthopaedic procedure types, with the exception of a slightly blunted increased rate of MHD risk accumulation in upper extremity surgeries.
KEY CONCEPTS: (1)The rate of change in the mental health disorder (MHD) risk was largely similar across procedure types, with the exception of a blunted increase in the upper extremity cohort.(2)Although younger patients had the lowest baseline prevalence of MHDs, they experienced the greatest relative increase in risk over time.(3)Although males had a higher presurgery MHD prevalence than females, females demonstrated a greater relative increase in risk over time, resulting in similar prevalence by 2 years postoperatively.
LEVEL OF EVIDENCE: 4.
METHODS: All patients aged ≤18 years undergoing pediatric orthopaedic surgery at a single academic medical center over a 10-year period were retrospectively identified by Current Procedural Terminology codes. Patients were categorized into 5 cohorts based on procedure type: lower extremity, upper extremity, spine, general, or multiple procedures. MHD-coded health care encounters (mood, anxiety, and behavioral/emotional disorders) were identified using International Classification of Diseases 10th Revision (ICD-10) codes and were assessed at baseline (12 months before surgery) and in 6-month intervals for up to 2 years after surgery. Individuals were considered to have a positive MHD outcome if they had at least 1 encounter containing an ICD-10 code for 1 of the included MHD categories. As the MHD outcome was evaluated as a cumulative risk, evidence of having MHD (ie, "yes") was carried forward over the remaining intervals following the first interval of a positive MHD diagnosis. Risk ratios (RR) of MHDs were estimated for each interval using the presurgical period as the reference. The ratio of risk ratios (RRR), a difference-in-difference estimand, was estimated to assess differences in the 2-year rate of change in MHD risk across cohorts, adjusting for age, sex, surgery time, and the COVID-19 period.
RESULTS: A total of 2,825 patients were included. Cohorts included lower extremity (n = 1,300; mean age: 11.4 years), upper extremity (n = 816; 8.7), spine (n = 386; 13.4), general (n = 170; 12.3), and multiple procedures (n = 153; 9.9). Presurgical baseline MHD prevalence ranged from 13% (upper extremity) to 18% (spine). All cohorts demonstrated higher cumulative MHD-coded encounter prevalence over the 2-year follow-up period. Pairwise comparisons found no meaningful difference in the rate of change in MHD risk between groups from 0 to 24 months, except for the upper extremity cohort which had a blunted increased rate of change in MHD risk compared to the lower extremity and spine cohorts.
CONCLUSIONS: At a single academic medical center, there was a similar rate of MHD risk accumulation following different pediatric orthopaedic procedure types, with the exception of a slightly blunted increased rate of MHD risk accumulation in upper extremity surgeries.
KEY CONCEPTS: (1)The rate of change in the mental health disorder (MHD) risk was largely similar across procedure types, with the exception of a blunted increase in the upper extremity cohort.(2)Although younger patients had the lowest baseline prevalence of MHDs, they experienced the greatest relative increase in risk over time.(3)Although males had a higher presurgery MHD prevalence than females, females demonstrated a greater relative increase in risk over time, resulting in similar prevalence by 2 years postoperatively.
LEVEL OF EVIDENCE: 4.