Youth With Eating Disorders Have a Higher 3-Month Rate of Adverse Postoperative Outcomes Following Common Orthopedic Surgeries

PURPOSE: To quantify surgery-related outcomes among patients ≤21 years old with eating disorders compared with the general youth population without eating disorders. METHODS: This retrospective cohort study identified youth up to 21 years of age with and without eating disorders who underwent spine, arthroscopy (ankle, knee, hip, shoulder), or fracture surgery between January 2016 and December 2022, utilizing the IBM MarketScan Multi-State Medicaid and Commercial Databases. Outcomes, including procedure-related infection, wound complication, systemic complication, implant/hardware complications, and "other" procedure-related complications, were examined up to 3 months following surgery. The incidence rate (IR) per 100 person-years and the IR ratio (IRR) were estimated for a composite of all 5 outcomes, the infection outcome only, and all 4 non-infection outcomes with a matched cohort without eating disorders. Cox regression estimated the hazard ratio (HR) after adjusting for the surgical type, age, sex, and insurance type. RESULTS: A total of 1057 youth patients undergoing qualifying orthopedic surgery were identified to have an eating disorder. The IR was 15.2 (95% CI=10.4-19.9) for the 5-outcome composite, 5.4 (95% CI=2.6-8.2) for the infection outcome, and 11.2 (95% CI=7.1-15.3) for the 4-outcome composite measure, which was 88% higher (IRR=1.88; 95% CI=1.37-2.58), 129% higher (IRR=2.29; 95% CI=1.35-3.88), and 72% higher (IRR=1.72; 95% CI=1.19-2.48), respectively, than the cohort without an eating disorder (n=170,582). There was effect modification by age for the infection outcome only beyond age 12; 1.87 (95% CI=1.04-3.38) by age 16 and 3.10 (95% CI=1.73-5.57) by age 19. CONCLUSIONS: Youth with eating disorders had a higher 3-month rate of adverse postoperative outcomes following orthopedic surgery, with a particularly pronounced rate of procedure-related infection beyond age 12. LEVEL OF EVIDENCE: Level III: Retrospective comparative study.