Selective Serotonin Reuptake Inhibitor Use is Associated with Increased Risk of Non-Union Following Foot and Ankle Arthrodesis: A Propensity-Matched Analysis.

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are the most prescribed pharmacotherapies for the treatment of major depressive disorder, but also confer deleterious effects on bone metabolism. The objective of this study was to investigate the association between perioperative SSRI exposure and non-union rates following foot and ankle fusion. Retrospective cohort study METHODS: The TriNetX Research Network was employed to identify patients between the ages of 18 and 89 years who underwent subtalar, tibiotalar, triple, or pantalar arthrodesis in the twenty year period ended May 26, 2023. Patients prescribed an SSRI within six months prior to foot and ankle arthrodesis represented the experimental group; absence of SSRI use within the same preoperative period denoted the control group. One-to-one propensity score matching was then conducted according to demographic characteristics and medical comorbidities. The diagnosis of non-union was assessed using hazard ratios (HR) derived from Kaplan-Meier survival analysis and log-rank test. A total of 2,216 pairs were included across all procedures. Rates of non-union were significantly elevated in the SSRI-exposed cohort at six months (HR 1.239), one year (HR 1.267), two years (HR 1.257), and three years postoperatively (HR 1.271). A similar trend was observed in tibiotalar arthrodesis individually, whereas no such association existed between SSRI use and non-union following subtalar arthrodesis and only within six months in triple arthrodesis candidates (HR 1.388). Surgeons may wish to evaluate SSRI use when planning foot and ankle arthrodesis procedures, particularly prior to tibiotalar fusion, given the increased likelihood of non-union. III.