Two-Year Cumulative Risk of Mental Health Disorders After Pediatric Orthopaedic Surgery: A Retrospective Cohort Study Comparing Procedure Types

Introduction Surgery can be psychologically challenging for pediatric patients and their families, yet the impact of pediatric orthopedic 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 two-year cumulative risk of common MHDs differed by the type of pediatric orthopaedic procedure. Methods All patients ≤18 years undergoing pediatric orthopedic surgery at a single academic medical center over a 10-year period were retrospectively identified by Current Procedural Terminology codes. Patients were categorized into five cohorts based on procedure type: lower extremity, upper extremity, spine, general, or multiple procedures. MHD-coded healthcare encounters (mood, anxiety, and behavioral/emotional disorders) were identified using International Classification of Diseases Tenth Revision (ICD-10) codes and were assessed at baseline (12 months pre-surgery) and in 6-month intervals for up to two years post-surgery. Individuals were considered to have a positive MHD outcome if they had at least one encounter containing an ICD-10 code for one of the included MHD categories. As the MHD outcome was evaluated as a cumulative risk, evidence of having MHD (i.e., “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 pre-surgical 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). Pre-surgical baseline MHD prevalence ranged from 13% (upper extremity) to 18% (spine). All cohorts demonstrated higher cumulative MHD- coded encounter prevalence over the two-year follow up period. Pairwise comparisons found no meaningful difference in the rate of change in MHD risk between groups from 0-24 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. Conclusion 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.