Antidepressant Prescription Use Correlated With Increased Complications Following Mandibular Fracture Surgery

Mental health factors are increasingly recognized as contributors to postoperative outcomes.

The purpose of the study was to measure the association between antidepressant prescription use and complications after open reduction and internal fixation (ORIF) of isolated mandible fractures.

This retrospective cohort study included patients with isolated mandible fractures, regardless of open or closed status, managed with ORIF between 2010 and 2023 using the PearlDiver Mariner database, a large, aggregated insurance claims database. Exclusion criteria were patients less than 18 years of age, concurrent long bone fractures, cervical spine injuries, midface fractures, multiple site mandible fractures, and records active for fewer than 90 days postfracture.

The primary exposure was antidepressant prescription use defined by the presence of documented antidepressant Uniform System of Classification codes 12 months prior to mandibular fracture.

Primary outcomes included overall 90-day postoperative complications, emergency department (ED) visits, and hospital readmissions.

Covariates assessed were comorbidities measured by the Charlson comorbidity index, age, sex, insurance type, tobacco use, alcohol use, narcotic use, and other substance use defined by (ICD-9-CM and ICD-10-CM) coding prior to mandible fracture.

The relative risks for the bivariate association between antidepressant prescription use and the primary outcomes were determined. A multivariable logistic regression model was used to evaluate the association between antidepressant prescription use and the primary outcomes adjusting for covariates. Significance defined as P ≤ .006 after Bonferroni correction for multiple comparisons.

The sample was composed of 16,616 subjects with a mean age of 37.8 ± 16.3 years, and 12,367 (74.4%) were males. Subjects with antidepressant prescription use had higher relative risk of overall postoperative complications (relative risk [RR] = 1.29; 95% CI: 1.18 to 1.40), ED visits (RR = 1.22; 95% CI: 1.14 to 1.31), and readmissions (RR = 1.21; 95% CI: 1.06 to 1.38) (P < .001 for all). After multivariable adjustments, subjects with antidepressant prescription use had higher odds of overall postoperative complications (odds ratio = 1.23; 95% CI: 1.10 to 1.39; P < .001) and ED visits (odds ratio = 1.16; 95% CI: 1.04 to 1.29; P = .001).

Preoperative antidepressant use was associated with higher postoperative morbidity after mandibular ORIF.