The surgical management of patients who deliberately self-harm.
BACKGROUND
Deliberate self-harm is a common problem that often requires orthopaedic treatment. Patients with injuries due to deliberate self-harm are often referred to our unit. This study assessed the type of treatment required and the cost of treatment.


METHODS
We undertook a retrospective survey of deliberate self-harm patients with known ICD-10 psychiatric disorders admitted for orthopaedic care from a medium-secure, female-only, psychiatric unit. Data were collected on admission rate, duration of stay, surgical interventions and complications.


RESULTS
Over a 36-month period there were 73 admissions for 15 patients (mean age, 25.1 years) requiring 65 operative interventions, a mean of 4.3 (range, 0-9) per patient. Over 50% of patients were admitted more than 3 times, totalling 416 hospital bed-days and 80% had methicillin-resistant Staphylococcus aureus (MRSA) isolated. The orthopaedic treatment costs for these patients was 453,000 pounds during the period studied.


CONCLUSIONS
The significant resources required to manage this patient cohort demonstrates the need for a co-ordinated management policy. We recommend day-case surgery for infected wounds only. Postoperatively, wounds should be protected with plaster of Paris. All patients with deliberate self-harm should be regarded as being infected with MRSA.
Rogers
B A
BA
Department of Orthopaedics, The Royal Sussex County Hospital, Brighton, UK. benedictrogers@hotmail.com
Pease
F
F
Ricketts
D M
DM
D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D003365:Costs and Cost Analysis; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000150:complications*; D019637:Orthopedic Procedures / Q000191:economics; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000191:economics / Q000523:psychology / Q000601:surgery*; D055815:Young Adult