Impact of mood disorders on postoperative outcomes following ankle open reduction and internal fixation

PurposeTo determine whether pre-existing mood disorders (MD) are associated with increased postoperative complications, healthcare utilization, and opioid use following ankle open reduction and internal fixation (ORIF).MethodsThis retrospective, propensity-matched cohort study utilized the TriNetX federated electronic health records database. Adults (≥18 years) undergoing ankle ORIF between January 1, 2004 and December 31, 2024 were stratified by presence or absence of a preoperative MD diagnosis and matched 1:1 for age, sex, race, ethnicity, BMI, diabetes, chronic kidney disease, and nicotine dependence. Outcomes included readmission, emergency department (ED) visits, physical therapy utilization, surgical site infection (SSI), deep vein thrombosis/pulmonary embolism (DVT/PE), and opioid use.ResultsAfter matching, 31,040 patients were included per cohort. At 3 and 6 months, MD patients demonstrated significantly higher rates of readmission (OR 1.69, 1.78), ED visits (OR 1.91, 2.01), physical therapy utilization (OR 1.24, 1.28), SSI (OR 1.55, 1.57), and DVT/PE (OR 1.45, 1.50), respectively (all p < 0.001). Opioid use was significantly elevated at all timepoints from 2 weeks through 1 year (OR range 1.48-1.67; all p < 0.001).ConclusionPre-existing mood disorders are associated with significantly worse outcomes following ankle ORIF, including elevated complication rates, greater healthcare utilization, and prolonged opioid use. These findings support routine preoperative mental health screening and multidisciplinary perioperative management in this population.