Preoperative Depression Influences Surgical Decision-Making and Worsens Outcomes After Achilles Tendon Repair.
Ruptures of the Achilles tendon are common, functionally debilitating injuries that can be managed nonoperatively or surgically. Preoperative depression has been associated with worse outcomes in orthopedic procedures, but its impact on surgical decision-making and recovery after Achilles repair is unclear.
This study evaluates the impact of preoperative depression on operative treatment rates and postoperative outcomes following Achilles tendon repair.
TriNetX database identified adults with Achilles tendon rupture (2005-2024). Patients were stratified by preoperative depression, with a secondary analysis comparing antidepressant users and non-users among depressed patients. Propensity score matching (1:1) was performed using demographic and clinical variables. Outcomes included 90-day postoperative complications and one-year outcomes. Relative risks (RRs) and P-values were calculated.
Among patients with Achilles tendon rupture, those with preoperative depression were less likely to undergo operative repair than those without depression (6.30% vs 7.40%; 1,067 vs 1,144; P=0.0008). Patients with depression experienced higher 90-day rates of infection (4.54% vs 2.31%, P=0.0015), acute postoperative pain (6.80% vs 3.60%, P<0.001), and physical therapy evaluation (32.0% vs 27.8%,P=0.0183). At one year, persistent ankle pain was more frequent in the depression cohort (29.19% vs 23.53%,P=0.0009). Among patients with depression, antidepressant use was associated with a higher likelihood of undergoing surgery (7.10% vs 5.90%; 359 vs 296; P=0.0110) and higher rates of acute postoperative pain (8.70% vs 4.90%, P = 0.027).
Preoperative depression was associated with altered surgical decision-making and worse postoperative outcomes following Achilles tendon repair. Although patients with depression were less likely to undergo surgery, those treated operatively experienced greater postoperative pain and poorer recovery. Antidepressant use increased the likelihood of surgery but did not mitigate postoperative risk. These findings highlight the importance of preoperative mental health assessment and targeted perioperative strategies.
This study evaluates the impact of preoperative depression on operative treatment rates and postoperative outcomes following Achilles tendon repair.
TriNetX database identified adults with Achilles tendon rupture (2005-2024). Patients were stratified by preoperative depression, with a secondary analysis comparing antidepressant users and non-users among depressed patients. Propensity score matching (1:1) was performed using demographic and clinical variables. Outcomes included 90-day postoperative complications and one-year outcomes. Relative risks (RRs) and P-values were calculated.
Among patients with Achilles tendon rupture, those with preoperative depression were less likely to undergo operative repair than those without depression (6.30% vs 7.40%; 1,067 vs 1,144; P=0.0008). Patients with depression experienced higher 90-day rates of infection (4.54% vs 2.31%, P=0.0015), acute postoperative pain (6.80% vs 3.60%, P<0.001), and physical therapy evaluation (32.0% vs 27.8%,P=0.0183). At one year, persistent ankle pain was more frequent in the depression cohort (29.19% vs 23.53%,P=0.0009). Among patients with depression, antidepressant use was associated with a higher likelihood of undergoing surgery (7.10% vs 5.90%; 359 vs 296; P=0.0110) and higher rates of acute postoperative pain (8.70% vs 4.90%, P = 0.027).
Preoperative depression was associated with altered surgical decision-making and worse postoperative outcomes following Achilles tendon repair. Although patients with depression were less likely to undergo surgery, those treated operatively experienced greater postoperative pain and poorer recovery. Antidepressant use increased the likelihood of surgery but did not mitigate postoperative risk. These findings highlight the importance of preoperative mental health assessment and targeted perioperative strategies.