Effect of Mental Health Diagnoses on Postoperative Outcomes and Secondary Treatment Utilization After Surgery for Adhesive Capsulitis: A Retrospective Large Database Analysis

Oct 21, 2025Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

How Mental Health Conditions Are Linked to Recovery and Additional Treatments After Surgery for Frozen Shoulder

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Abstract

Among 42,862 patients, 26.1% had a preoperative mental health diagnosis.

Patients with a mental health disorder had a 33% higher risk of hospital readmission within 90 days.
Emergency department visits were 81% more likely in patients with preexisting mental health conditions.
Postoperative complications included a higher risk of acute kidney injury (60%), wound complications (63%), pneumonia (46%), urinary tract infections (22%), and stroke (75%).
Two years post-surgery, patients with mental health disorders were more likely to receive physical therapy (18%), intra-articular injections (27%), and any secondary treatment (22%).
Over a 10-year period, there was a higher cumulative incidence of physical therapy (53.7% vs. 52.0%), intra-articular injections (32.0% vs. 28.6%), and any secondary treatment (64.9% vs. 62.7%) among those with mental health disorders.

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INTRODUCTION: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Key numbers

1.33

Increase in Hospital Readmission Risk

Odds ratio for hospital readmission within 90 days after surgery

53.7%

Physical Therapy Utilization

Cumulative incidence of physical therapy utilization at 10 years

1.20

Increase in Intra-articular Injection Risk

Hazard ratio for intra-articular injection utilization at 10 years

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Effect of Mental Health Diagnoses on Postoperative Outcomes and Secondary Treatment Utilization After Surgery for Adhesive Capsulitis: A Retrospective Large Database Analysis

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