Effects of Preoperative Psychiatric Medication Utilization on Outcomes of Midfoot, Hindfoot, and Ankle Fusions

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Psychiatric medication use is common in surgical patients and has been linked to altered pain perception, immune modulation, and delayed bone healing. However, its impact on foot and ankle fusion outcomes remains unclear. This study investigates the influence of preoperative psychiatric medication use on outcomes following midfoot, hindfoot, and ankle arthrodesis. Methods: This retrospective study utilized the TriNetX database (2005-2025) to compare two cohorts of patients undergoing midfoot, hindfoot, or ankle fusion. Cohort 1 included patients with psychiatric medication use within one year preoperatively, while cohort 2 had no psychiatric medication usage before surgery. Propensity score matching (1:1) accounted for demographics and comorbidities, yielding 5,062 patients per cohort. The psychiatric medication cohort (46.1% female) had a mean age of 53.4 years and BMI of 28.6 kg/m 2 ; the control cohort (45.9% female) had a mean age of 53.6 years and BMI of 29.0 kg/m 2 . Results: At six months, psychiatric medication users had higher risks of fusion reoperation (RR: 2.344; 95% CI: 1.743–3.154), hardware removal (RR: 1.448; CI: 1.175–1.783), and implant-related pain (RR: 1.419; CI: 1.145–1.760), but a lower risk of pseudoarthrosis (RR: 0.616; CI: 0.542–0.701). At two years, these patients remained at higher risk for implant-related pain (RR: 1.667; CI: 1.204–2.308), fusion reoperation (RR: 2.138; CI: 1.379–3.316), and hardware removal (RR: 1.415; CI: 1.033–1.939). A slight increase in deep surgical site infections (RD: 0.002; CI: 0.001–0.004) was observed but is likely not clinically significant. Conclusion: Preoperative psychiatric medication use is associated with increased risks of hardware-related complications and infections following midfoot, hindfoot, or ankle arthrodesis, though a lower rate of nonunion. These findings underscore the importance of recognizing the impact preoperative psychiatric medication usage can have on foot and ankle arthrodesis outcomes. Additional research is needed to further understand these findings.