Psychiatric comorbidities, postoperative pain, and healthcare utilization after ankle repair: A propensity-matched analysis.

Abstract

Psychiatric comorbidities, including post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and depression, are common among patients with orthopedic trauma and may negatively affect postoperative recovery; however, their impact after ankle repair is not well defined. To evaluate whether adults undergoing ankle repair with preexisting PTSD, GAD, or depression have increased risks of postoperative opioid exposure, chronic pain, emergency department (ED) utilization, and short-term complications compared with matched controls. Retrospective propensity score-matched cohort study. Using the TriNetX US Collaborative Network, adults ≥18 years who underwent ankle repair (2005-2025) were identified. Patients with PTSD, GAD, or depression were matched 1:1 to controls without psychiatric diagnoses based on demographic and clinical factors. The primary outcome was opioid exposure within 30 days postoperatively. Secondary outcomes included chronic pain, surgical site infection, sepsis, delirium, ED visits, and reoperation. After matching, 2,864 PTSD, 6,993 GAD, and 4,595 depression patients were analyzed. Psychiatric cohorts had higher 30-day opioid exposure, three- to fivefold higher chronic pain, and increased ED utilization (all P < 0.001). PTSD was associated with higher reoperation rates, and GAD with increased delirium. Infection and sepsis rates were similar. Preexisting PTSD, GAD, and depression are independently associated with increased opioid exposure, chronic pain, and ED utilization after ankle repair, supporting targeted perioperative risk stratification and multidisciplinary care.