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Possible Association between Rotator Cuff Repair and Suicide: A Nationwide Cohort Study Using Propensity Score
Hyojune Kim1, Ha Jun Jang2, Kyoung Hwan Koh3
1Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Korea.
Clinics in Orthopedic Surgery
|October 20, 2025
Summary
Patients undergoing rotator cuff repair (RCR) surgery face increased suicide risk, particularly after the first postoperative year. This highlights the need for enhanced psychological support and monitoring following RCR.
Area of Science:
- Orthopedic Surgery
- Psychiatry
- Public Health
Background:
- Rotator cuff repair (RCR) surgery can lead to significant psychological distress for patients due to pain, rehabilitation challenges, functional limitations, and retear risks.
- The incidence and risk of suicide among patients following RCR are not well understood.
Purpose of the Study:
- To investigate the incidence rate of suicide-related death over time in patients who underwent RCR.
- To analyze the association between RCR and suicide risk using a large, nationwide cohort database.
Main Methods:
- A nationwide cohort of 3,992 RCR patients and 3,992 matched controls from the National Health Insurance Service (NHIS) Sample cohort (2007-2018) was analyzed.
- Time-dependent propensity score matching was employed, and suicide cumulative incidence was assessed using Kaplan-Meier curves and log-rank tests.
- Suicide incidence rates and hazard ratios were calculated using generalized linear models and Cox proportional hazards models.
Main Results:
- The incidence rate of suicide among RCR patients was 62.61 per 100,000 person-years for over one year post-surgery.
- RCR patients were 3.19 times more likely to die by suicide during the entire follow-up and 5.86 times more likely after one year compared to controls.
Conclusions:
- No increased suicide association was found within the first year post-RCR, but a significant trend emerged thereafter.
- Post-RCR challenges like pain, rehabilitation difficulties, and retear risk may impact psychological well-being.
- Close monitoring and timely psychiatric interventions are crucial for patients following RCR.
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