Possible Association between Rotator Cuff Repair and Suicide: A Nationwide Cohort Study Using Propensity Score Matching.

Backgroud: Following rotator cuff repair surgery (RCR), patients can face considerable psychological distress due to factors such as ongoing intense pain, difficulties in the rehabilitation process, remnant functional limitations, and the potential risk of complications such as retear. The incidence and risk of suicide in these patients are poorly understood. Therefore, we aimed to investigate the incidence rate (IR) of suicide-related death over time and analyze the association between RCR and suicide using a representative nationwide large cohort database. Methods: We selected RCR patients from the National Health Insurance Service (NHIS) Sample cohort (2007-2018) and a control group without rotator cuff tear. A time-dependent 1:1 propensity score matching (standardized differences < 0.1) was performed. Suicide cumulative incidence was analyzed using Kaplan-Meier curves and the stratified log-rank test. The suicide IR and 95% CI were calculated with a generalized linear model (Poisson distribution). The effect size was presented as a hazard ratio (HR) using Cox's proportional hazards model with robust variance to account for clustering within matched pairs. Results: We included 3,992 incident RCR patients and 3,992 matched controls. The IR of suicide among RCR patients was 62.61 per 100,000 person-years for a period of more than 1 year and 56.15 per 100,000 person-years (95% CI, 32.61-96.68) during the entire follow-up period. During the entire follow-up and a period of more than 1 year after RCR, RCR patients were 3.19 times and 5.86 time more likely to die by suicide than their matched controls (95% CI, 1.04-9.76; Conclusions: Patients who underwent RCR demonstrated no association with suicide within the first postoperative year, but a noticeable trend of increased suicide incidence emerged after this period. This finding suggests the potential impact of challenges, such as intense pain, rehabilitation difficulties, persistent functional limitations, and RC retear, on the psychological well-being of patients following RCR. It is imperative that these patients receive close monitoring and appropriate interventions for timely and appropriate psychiatric care.