The Impact of Socially Stigmatized Pre-Existing Conditions on Outcomes After Injury

Lucy posing with a group of people.




Associate Professor of Surgery at the Hospital of the University of Pennsylvania and the Presbyterian Medical Center of Philadelphia

Project Summary


Socially stigmatizing pre-existing conditions (SSPEC), including alcohol use disorder, drug use disorder, and major psychiatric illness, may lead to provider minimization of patient symptoms and have been associated with negative outcomes in orthopedic and general trauma patient populations. However, the impact of SSPECs on failure to rescue (FTR; death preceded by a complication) has not been evaluated. The aim of our study was to assess the relationship between SSPEC and the risk of complications, mortality, and FTR for trauma patients. We hypothesized that increased SSPEC burden would be associated with increased complications, mortality, and FTR.

We conducted a retrospective analysis of the 2015 National Trauma Data Bank (NTDB), which included analyzing patient demographics, complication types, and patterns of injury intent and mechanism between patients with and without SSPEC. We performed univariate analysis on different variables that we hypothesized to be associated with SSPEC. With SSPEC as the primary exposure, we built multivariable logistic regression models on complications, mortality, and FTR while controlling for patient demographics, physiology, and injury severity.

In conclusion, we found that patients with SSPEC have a higher risk of complications but a lower risk of mortality and FTR, compared to patients without SSPEC. These results alleviate concerns about poorer mortality and FTR outcomes for patients with SSPEC. However, we plan to further investigate the differences in certain complications that seem to be associated with SSPEC. We plan to conduct further investigation into each particular type of SSPEC—alcohol use disorder, drug use disorder, and major psychiatric illnesses—in hopes of revealing important opportunities for improvement.

My experience in clinical outcomes research has engendered my transition from student to contributor. Under the guidance of my mentor, Dr. Daniel Holena, I have been able to engage in a hands-on learning process and gain transferrable skills, such as leading a research project or coding in a statistical data analysis program. Research presents the unique opportunity to apply classroom concepts and textbook knowledge toward answering real-world questions and problems. Additionally, through the opportunity to conduct my own research study, I learned to be primarily responsible for determining the pace of our project’s progress, which challenged me to take initiative of my learning through studying previous literature, asking questions, and engaging actively with the project. I am immensely grateful to Dr. Holena and the whole research team for encouraging me to take ownership of my ideas, to think critically about complex research concepts, and to step out of my comfort zone and undertake tasks and goals I had not thought were possible. Their support and guidance have helped me become more comfortable with challenging myself as a researcher and thinker, and the intangible qualities and experiences I have gained will continue to inform my future academic and professional endeavors.