Purpose
To investigate the association between preoperative mental health disorders and postoperative
complications, readmissions, and ipsilateral revision procedures among patients undergoing
arthroscopic rotator cuff repair (RCR).
Methods
A retrospective cohort study from 2010 to 2020 was performed using the PearlDiver
database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without mental health disorders who
underwent arthroscopic RCR. Mental health disorders evaluated in this study include
depressive disorder, major depressive disorder, major depressive affective disorder,
bipolar disorder, dysthymic disorder, adjustment disorder, separation anxiety disorder,
and posttraumatic stress disorder. Patients were matched at a 1:1 ratio based on age,
sex, Charlson Comorbidity Index, body mass index, and tobacco use. Rates of complications
and subsequent surgeries were compared between patients with and without a preoperative
diagnosis of a mental health disorder.
Results
The 1-year preoperative prevalence of a mental health disorder from 2010 to 2020 was
14.6%. After 1:1 matching, patients with a mental health disorder who underwent arthroscopic
RCR were nearly twice as likely to undergo a revision procedure (odds ratio 1.94,
95% confidence interval 1.76-2.14, P < .001) and more than twice as likely to experience conversion to shoulder arthroplasty
(odds ratio 2.29, 95% confidence interval 1.88-2.80, P < .001) within 2 years of initial arthroscopy when compared with patients without
a mental disorder. Patients with a mental disorder also experienced increased risk
for 90-day readmission (1.9% vs 0%, P < .001) as well as multiple postoperative medical complications.
Conclusions
Patients with pre-existing mental health diagnoses experience increased rates of 90-day
postoperative complications and readmissions following arthroscopic RCR. In addition,
patients with mental health diagnoses are more likely to undergo revision repair and
conversion to shoulder arthroplasty within 2 years of the index procedure.
Level of Evidence
Level III.
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Article info
Publication history
Published online: August 12, 2022
Accepted:
June 25,
2022
Received:
December 22,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.L.Z. reports personal fees from Stryker and DePuy Mitek, outside the submitted work. B.T.F. reports grants from the National Institutes of Health, United States Department of Veterans Affairs, Orthofix, and Stryker, outside the submitted work; and Editorial Board, Journal of Shoulder and Elbow Surgery and Current Reviews in Musculoskeletal Medicine. C.B.M. reports personal fees from Stryker, grants from Conmed, personal fees from Conmed, personal fees from Tornier, grants from Aseculap, grants from Samumed, and grants from Zimmer, outside the submitted work. D.A.L. reports personal fees from Vericel and AlloSource, grants from AANA, American Orthopaedic Society for Sports Medicine, and the Arthritis Foundation, and other support from Arthrex/Evolution Surgical and Stryker, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
