Pre-existing Mental Health Diagnoses Are Associated with Higher Rates of Postoperative Complications, Readmissions, and Reoperations Following Arthroscopic Rotator Cuff Repair.

PURPOSE: To investigate the association between pre-operative mental health disorders and post-operative complications, readmissions, and ipsilateral revision procedures amongst 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 (CPT) and International Classification of Diseases (ICD) 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 pre-operative diagnosis of a mental health disorder.

RESULTS: The one-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 (OR: 1.94, 95% CI: 1.76-2.14, p<0.001) and more than twice as likely to experience conversion to shoulder arthroplasty (OR: 2.29, 95% CI: 1.88-2.80, p<0.001) within two years of initial arthroscopy when compared to patients without a mental disorder. Patients with a mental disorder also experienced increased risk for 90-day readmission (1.9% vs. 0%, p<0.001) as well as multiple postoperative medical complications.

CONCLUSION: 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 two years of the index procedure.