Impact of Diagnosed Mental Health Disorders on Postoperative Outcomes After Achilles Tendon Repair.

BACKGROUND: This study evaluated the association between diagnosed mental health disorders and postoperative outcomes following Achilles repair.

METHODS: A retrospective cohort study was performed using the TriNetX database over a 20-year period. Patients were divided into 2 cohorts based on whether they had a documented mental health disorder (eg, anxiety or depression) 1 year preceding surgery. Cohorts were propensity score matched by demographics such as age, gender, body mass index, diabetes, and hypertension. Outcomes were measured 90 days, 3 years, and up to 10 years using odds ratios with 95% CIs. χ2 analysis was performed with significance noted at P <.05.

RESULTS: Matched cohorts had a mean age of 48.5 years in the mental health cohort and 49.6 years in the control cohort, with 47.4% vs 47.1% female patients, respectively. A total of 1841 patients were included in each cohort. Within 90 days postoperative, patients with diagnosed mental health disorders demonstrated several significant outcomes such as higher odds of orthopaedic aftercare (P = .032), infection following a procedure (P < .0001), postoperative pain (P < .0001), emergency department visit (P < .0001), ankle pain (P = .004), cellulitis of lower limb (P < .0001), and foot pain (P = .009). Within 3 years postoperative, these patients had significantly higher odds of knee pain (P = .008), ankle osteoarthritis (P = .003), Achilles tendonitis (P = .008), and abnormalities of gait and mobility (P = .020). Within 10 years postoperative, these patients had significantly higher odds of ankle osteoarthritis (P = .006).

CONCLUSION: Diagnosed mental health disorders are associated with increased short- and long-term adverse postoperative outcomes in patients who underwent Achilles repair at a population level. These associations included increased infection rates and pain, as well as later musculoskeletal diagnoses such as ankle osteoarthritis and abnormalities with gait.

LEVEL OF EVIDENCE: Level III, retrospective, comparative cohort study.