Impact of Pediatric Neuropsychiatric Disorders on Postoperative Outcomes Following Common Nonspine Orthopedic Surgeries

Background: Pediatric fractures are common injuries, and the increasing prevalence of neuropsychiatric conditions like ADHD, autism, anxiety, and depression may complicate postoperative outcomes. Understanding how these diagnoses affect surgical recovery is essential for optimizing care in this vulnerable population. Methods: This study analyzed data from the 2019 and 2022 Kids Inpatient Database. Children undergoing common nonspine orthopedic procedures were identified and matched one-to-one by age, sex, ethnicity, and severity of illness. Primary outcomes included postoperative complications, such as infection and mechanical implant failures; secondary outcomes were length of stay and total hospital charges. Logistic regression models were used to adjust for potential confounders. Results: Among 4931 ADHD-matched pairs, patients with ADHD had longer mean hospital stays (5.07 vs. 4.69 d, P =0.041) and significantly increased risk of osteomyelitis (OR: 1.42, P =0.0017) and soft tissue infection (OR: 1.39, P =0.009). For 5673 anxiety-matched pairs, anxiety correlated with higher mean length of stay (7.16 vs. 5.54 d, P <0.01) and elevated odds of soft tissue infections (OR: 1.55, P <0.01), mechanical implant complications (OR: 1.28, P =0.036), and constipation (OR: 2.03, P <0.01). Depression (2950 matched pairs) was associated with longer stays (8.31 vs. 6.00 d, P <0.01) and greater risk of osteomyelitis (OR: 2.04, P <0.01). Among 2322 autism-matched pairs, autism did not significantly impact length of stay but increased pneumonia risk (OR: 1.76, P =0.025) and postoperative ileus (OR: 1.71, P =0.040). Conclusion: These findings demonstrate the significant impact of neuropsychiatric comorbidities on pediatric orthopedic recovery. Behavioral factors, such as impulsivity or anxiety-driven movement avoidance, and physiological mechanisms, including altered immune function, may drive elevated complication rates. Tailored perioperative management, including mental health screening, specialized communication strategies, and enhanced caregiver support, could improve adherence and reduce morbidity for these patients. Further research should focus on targeted interventions, medication considerations, and strategies that foster cooperation among orthopedic, mental health, and rehabilitative services. Addressing these challenges can ultimately enhance the quality of care and reduce disparities for pediatric patients with coexisting orthopedic injuries and neuropsychiatric diagnoses. Level of Evidence: Level III—retrospective comparative study.