Preoperative SSRI Use and Complications After Ankle and Hindfoot Open Reduction Internal Fixation: A Propensity-Matched Database Study.

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) are increasingly used for depression and anxiety, with some studies suggesting they may impair bone mineral density and fracture healing. This study aims to investigate the impact of SSRIs on ankle and hindfoot open reduction and internal fixation (ORIF) outcomes.

METHODS

A retrospective review of the TriNetX database (2005-2023) identified patients undergoing ORIF for ankle, talus, calcaneus, or pilon fractures. Two cohorts were created: those with an active SSRI prescription at least 3 months prior to surgery and those without an SSRI prescription. Propensity score matching (1:1) adjusted for demographics, comorbidities, procedure type, and open fracture status, yielding 12 612 patients per cohort. Mean age was 52.3 vs 52.3 years, body mass index 31.8 vs 31.1, and follow-up 947 vs 880 days for SSRI and control groups, respectively.

RESULTS

At 6 months postoperatively, the SSRI cohort demonstrated significantly increased risks of readmission (risk ratio [RR] 1.155, 95% CI 1.043-1.278, P = .005), acute kidney failure (RR 1.268, 95% CI 1.092-1.473, P = .002), emergency department utilization (RR 1.095, 95% CI 1.027-1.168, P = .006), pulmonary embolism (RR 1.506, 95% CI 1.146-1.979, P = .003), and urinary tract infection (RR 1.243, 95% CI 1.092-1.414, P = .001), whereas the risk of sepsis was decreased (RR 0.798, 95% CI 0.643-0.990, P = .040). At 2 years, SSRI use was associated with higher risks of wound dehiscence (RR 1.750, 95% CI 1.188-2.579, P = .004), implant-related pain (RR 1.318, 95% CI 1.169-1.485, P < .001), and conversion to fusion (RR 1.735, 95% CI 1.139-2.644, P = .009).

CONCLUSION

Preoperative SSRI use was associated with increased medical and surgical complications after ankle and hindfoot ORIF, warranting further investigation and perioperative risk counseling.