Foot & Ankle Orthopaedics · Published 2026-04-01 · DOI 10.1177/24730114261457093
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. χ 2 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.
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