Impact of Antidepressant Use on Complications Following Ankle Fracture Management: A Multi-institutional Propensity-Matched Cohort Analysis

Abstract

Background:

This study evaluated the relationship between antidepressant prescription (ADP) and postoperative complications in patients undergoing ankle open reduction internal fixation (ORIF).

Methods:

A retrospective cohort study that uses multi-institutional data from the Trinetx research platform identified patients who underwent ankle ORIF on or before December 10, 2024, with at least 2 ADP doses and 2 years of follow-up using Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) codes. Outcomes were grouped into 90-day systemic and 2-year mechanical complication families. The false discovery rate was controlled at 5% using the Benjamini-Hochberg procedure, and results are reported as risk ratios with 95% CIs.

Results:

Of 70 813 patients, 13 610 (19.2%) used antidepressants. After matching (11.071 per group), antidepressant use was associated with significantly higher rates of short-term complications, including infection, wound disruption, and hospital readmission. At 2-year follow-up, use of antidepressants was significantly associated with increased rates of mechanical complications, including higher rates of hardware failure, osteoarthritis, removal, nonunion, and amputation. The outcomes remained significant after multiple-testing adjustment.

Conclusion:

Preoperative antidepressant prescription was associated with increased postoperative and long-term complications after ankle ORIF. These observational findings support tailored perioperative management and monitoring, particularly for patients with preoperative antidepressant prescriptions.

Graphical Abstract

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