Effect of Mental Health Diagnoses on Postoperative Outcomes and Secondary Treatment Utilization After Surgery for...

Adhesive capsulitis (AC) is a debilitating condition that markedly affects shoulder mobility and function. Mental health disorders have been associated with poorer outcomes for orthopaedic patients; however, their specific effect on postoperative outcomes after surgery for AC remains underexplored.

Patients who underwent arthroscopic capsular release or manipulation under anesthesia for AC were identified in the PearlDiver database. Patients with preexisting mental health diagnoses (anxiety, depression, bipolar disorder, or schizophrenia) were matched 1:1 with control subjects based on age, sex, and Charlson Comorbidity Index. Rates of 90-day complications and 2-year surgical outcomes were analyzed through multivariable logistic regression. Kaplan-Meier analyses generated 10-year cumulative incidence rates of postoperative therapeutic modalities, and a Cox proportional hazard ratio (HR) model generated HRs and 95% confidence intervals.

Among 42,862 patients identified, 26.1% had a preoperative mental health diagnosis. After matching, patients with a mental health disorder experienced greater risk for 90-day hospital readmission (odds ratio [OR] = 1.33, P < 0.001), emergency department visits (OR = 1.81, P < 0.001), and several postoperative complications, including acute kidney injury (OR = 1.60, P < 0.001), wound complications (OR = 1.63, P = 0.028), pneumonia (OR = 1.46, P < 0.001), urinary tract infection (OR = 1.22, P < 0.001), and stroke (OR = 1.75, P = 0.005). Patients with mental health disorders were also more likely to undergo physical therapy (OR = 1.18, P < 0.001), intra-articular injections (OR = 1.27, P < 0.001), and any secondary treatment (OR = 1.22, P < 0.001) 2 years after surgery. In addition, preexisting mental health disorders were associated with an increased 10-year cumulative incidence and risk of physical therapy (53.7% versus 52.0%, HR = 1.09, P 0.001), intra-articular injections (32.0% versus 28.6%, HR = 1.20, P < 0.001), and any secondary treatment (64.9% versus 62.7%, HR = 1.10, P < 0.001).

Patients with existing mental health disorders experienced increased rates of complications and a higher risk of secondary treatment utilization over a 10-year period after surgery for AC. Awareness of these risks is essential for optimizing postoperative care and addressing the complex needs of this patient population.