Depressive Disorder and Trimalleolar Fractures: An Analysis of Outcomes and Costs

Category: Trauma; Hindfoot Introduction/Purpose: The prevalence of depression is rising globally, and it has been noted in recent literature that the COVID-19 pandemic has exacerbated the increase in depressive disorders. Studies have suggested a strong association between depression and poor outcomes following various orthopedic surgeries, particularly joint arthroplasties. However, depression’s impact on complications following open reduction/internal fixation (ORIF) of Trimalleolar fractures has not been elucidated, despite the high complication rate of this procedure. Therefore, the aims of this study were to determine whether depression is associated with higher rates of 1) readmissions and 2) medical complications following ORIF of Trimalleolar fractures. Methods: Using the Mariner nationwide database from January 1, 2010, to March 31, 2021, a total of 50,154 adults aged 18 or older were identified as having undergone Trimalleolar ORIF using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) coding. Patients with depression were matched 1:1 to controls without depression by age, sex, COPD, anxiety, diabetes, hypertension, obesity, and tobacco use. Primary endpoints compared 90-day all-cause readmissions and medical complications. Logistic regression was used to calculate odds-ratios (OR) of the effect of depression on readmissions and medical complications. A p-value of less than 0.05 was significant. Results: Patients with depression who underwent ORIF of Trimalleolar fractures had significantly higher odds of being readmitted within 90-days of the initial procedure (OR: 1.37; 95%CI: 1.27 – 1.48; p< 0.0001). 90-day odds of developing medical complications were significantly higher (OR: 4.61; 95%CI: 4.38 – 4.86; p< 0.0001) in patients with depression compared to patients within the control group. Conclusion: This study demonstrated that patients with depression undergoing Trimalleolar ORIF are at an increased risk of readmission and a multitude of postoperative complications. This information is crucial for orthopedic surgeons considering the already high burden of complications following ORIF of Trimalleolar fractures and increasing prevalence of depression worldwide.