Preoperative Depression is Associated with Increased Complications Following Ankle Fracture Surgery

Abstract

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are a common injury treated by orthopaedic surgeons with a rising incidence. Preoperative depression is a known risk factor for postoperative complications in joint replacement surgery, however its effects on outcomes following ankle fracture surgery is unknown. The purpose of this study was to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods: In this retrospective study, the Truven MarketScan claims database was used to identify patients who underwent outpatient ankle fracture surgery from January 2009 to December 2018 using Common Procedure Terminology (CPT) codes. Patient characteristics, and medical comorbidities were collected. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to investigate the association between preoperative depression and common postoperative complications following ankle fracture surgery. Results: In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (OR 1.33, CI 1.20-1.46), wound complications (OR 1.13, CI 1.00-1.28), pain-related postoperative emergency department visits (OR 1.58, CI 1.30-19.1), 30-day and 90-day readmissions (OR 1.08, CI 1.03-1.21 and OR 1.13, CI 1.07-1.18), sepsis (OR 1.39, CI 1.12-1.72) and postoperative development of complex regional pain syndrome (OR 1.46, CI 1.18-1.81). Conclusion: Preoperative depression in patients undergoing ankle fracture surgery is common and associated with increased complications following surgery. An understanding of patients' preoperative depression diagnosis can allow providers to modify perioperative and postoperative protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor.