Abstract
PurposeWith the increasing elderly population and obesity epidemic, diabetes is an important factor in arthroplasty planning. Although research suggests diabetes is associated with increased postoperative morbidity after hip and knee replacement, the effect of diabetes and varying management with insulin versus non-insulin agents on total shoulder arthroplasty (TSA) is not established.MethodsAll TSAs from 2015 to 2016 were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Age, gender, BMI, steroid, ASA, operative time, and smoking status were compared between all diabetics, diabetics on insulin, diabetics on non-insulin agents, and non-diabetics to account for confounding variables. Thirty-day postoperative complications, readmission rate, surgical site infection (SSI), and non-routine discharge to rehabilitation were compared using bivariate and multivariate binary logistic regression. Postoperative time to discharge between diabetic groups was analyzed using univariate ANOVA with Tukey’s test.ResultsThe analysis included 7246 patients (insulin in 5% (n = 380), non-insulin in 13% (n = 922), and non-diabetics in 82% (n = 5944)). Diabetics were more likely to have an ASA ≥ 3 compared to non-diabetics (89.5% vs 50.1%; p < 0.001). Bivariate logistic regression showed statistical significance in readmission and non-routine discharge between all diabetics and non-diabetics (OR 1.7, 1.4; p = 0.001, 0.001), but there was no significance between SSI rate (0.3% vs 0.4%; p = 0.924). Multivariate logistic regression between groups showed significance in readmission between non-insulin diabetics vs non-diabetics (OR 1.5; p = 0.027), readmission and non-routine discharge in insulin vs non-diabetics (OR 2.1, 1.7; p = 0.003, < 0.001), and no significance between insulin and non-insulin diabetics. Postoperative days to discharge were 2.4, 2.0, and 1.8 days in insulin, non-insulin, and non-diabetics respectively. Mean differences were significant between all groups.ConclusionsDiabetic patients are at a higher risk for readmission and non-routine discharge compared to non-diabetics. Despite no increased risk in SSI, longer postoperative discharge time in diabetics should be considered in TSA planning.Trial registrationNot applicableLevel of evidenceLevel III, case-control study
Highlights
With the increasing elderly population and rising obesity epidemic, diabetes mellitus is an important factor to consider in arthroplasty planning
The aim of this study was to analyze the impact of diabetes and differences within the diabetics, characterized as non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM), on postoperative complications and discharge time in patients undergoing total shoulder arthroplasty (TSA)
From 2015 to 2016, a total of 7246 patients undergoing TSAs were included in the study, including non-diabetics in 82% (n = 5944), NIDDM in 13% (n = 922), and IDDM in 5% (n = 380) (Table 1)
Summary
With the increasing elderly population and rising obesity epidemic, diabetes mellitus is an important factor to consider in arthroplasty planning. The proportion of diabetic patients with functional disability is quickly increasing worldwide and is already becoming a major public health issue. The prevalence of diabetes is projected to increase by 69% in developing countries and 20% in developed countries between 2010 and 2030 [2]. Disease duration, and vascular complications in a growing elderly population, the prevalence of musculoskeletal manifestations of type 1 and type 2 diabetes is as high as 30% of diabetic patients according to recent studies [3]. Increases in non-homebound discharge, length of stay, and total hospital charges in diabetics undergoing elective TSAs are important factors to consider in arthroplasty planning
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