Association of polypharmacy and medication class diversity with postoperative complications following operative ankle fracture repair

BACKGROUND: Polypharmacy is increasingly common and may influence outcomes following orthopedic trauma. While specific medication classes have been associated with complications in arthroplasty and spine surgery, the role of total preoperative medication count in ankle trauma remains unclear. This study evaluated whether polypharmacy and medication class diversity were independently associated with postoperative complications after operative ankle fracture repair. METHODS: A retrospective cohort study included 178 adult patients who underwent operative fixation of ankle fractures at a single academic medical center. Preoperative medication burden was assessed using total outpatient medication count and medication class diversity. Postoperative outcomes included deep vein thrombosis (DVT), surgical site infection, nonunion, malunion, and surgical revision. Multivariable logistic regression models were constructed for each medication exposure, adjusting for age, sex, Charlson Comorbidity Index, American Society of Anesthesiologists class, and smoking status. Associations with nonunion and malunion were not significant. CONCLUSIONS: Preoperative medication burden may be associated with postoperative complications after ankle fracture repair. Medication class diversity shows broader associative utility and may serve as a useful adjunct to risk stratification.