Matthew L Webb1, Nicholas S Golinvaux2, Izuchukwu K Ibe3, Patawut Bovonratwet3, Matthew S Ellman4, Jonathan N Grauer3. 1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee. 3. Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut. 4. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Abstract
BACKGROUND: Total knee arthroplasty (TKA) is an effective treatment option for patients with advanced osteoarthritis and has become one of the most frequently performed orthopedic procedures. With the increasing prevalence of diabetes mellitus (DM), the burden of its sequela and associated surgical complications has also increased. For these reasons, it is important to understand the association between DM and the rates of perioperative adverse events after TKA. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent TKA between 2005 and 2014 were identified and characterized as having insulin-dependent DM (IDDM), non-insulin-dependent DM (NIDDM), or not having DM. Multivariate Poisson regression was used to control for demographic and comorbid factors and to assess the relative risks of multiple adverse events in the initial 30 postoperative days. RESULTS: A total of 114,102 patients who underwent TKA were selected (IDDM = 4881 [4.3%]; NIDDM = 15,367 [13.5%]; and no DM = 93,854 [82.2%]). Patients with NIDDM were found to be at greater risk for 2 of 17 adverse events studied relative to patients without DM. However, patients with IDDM were found to be at greater risk for 12 of 17 adverse events studied relative to patients without DM. CONCLUSION: In comparison with patients with NIDDM, patients with IDDM are at greater risk for many more perioperative adverse outcomes relative to patients without DM. These findings have important implications for patient selection, preoperative risk stratification, and postoperative expectations.
BACKGROUND:Total knee arthroplasty (TKA) is an effective treatment option for patients with advanced osteoarthritis and has become one of the most frequently performed orthopedic procedures. With the increasing prevalence of diabetes mellitus (DM), the burden of its sequela and associated surgical complications has also increased. For these reasons, it is important to understand the association between DM and the rates of perioperative adverse events after TKA. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent TKA between 2005 and 2014 were identified and characterized as having insulin-dependent DM (IDDM), non-insulin-dependent DM (NIDDM), or not having DM. Multivariate Poisson regression was used to control for demographic and comorbid factors and to assess the relative risks of multiple adverse events in the initial 30 postoperative days. RESULTS: A total of 114,102 patients who underwent TKA were selected (IDDM = 4881 [4.3%]; NIDDM = 15,367 [13.5%]; and no DM = 93,854 [82.2%]). Patients with NIDDM were found to be at greater risk for 2 of 17 adverse events studied relative to patients without DM. However, patients with IDDM were found to be at greater risk for 12 of 17 adverse events studied relative to patients without DM. CONCLUSION: In comparison with patients with NIDDM, patients with IDDM are at greater risk for many more perioperative adverse outcomes relative to patients without DM. These findings have important implications for patient selection, preoperative risk stratification, and postoperative expectations.
Keywords:
NSQIP; diabetes mellitus; insulin-dependent diabetes mellitus; non–insulin-dependent diabetes mellitus; the American College of Surgeons National Surgical Quality Improvement Program; total knee arthroplasty
Authors: Patawut Bovonratwet; Daniel D Bohl; Glenn S Russo; Nathaniel T Ondeck; Denis Nam; Craig J Della Valle; Jonathan N Grauer Journal: Clin Orthop Relat Res Date: 2018-03 Impact factor: 4.176
Authors: Angela T Chen; Corin I Bronsther; Elizabeth E Stanley; A David Paltiel; James K Sullivan; Jamie E Collins; Tuhina Neogi; Jeffrey N Katz; Elena Losina Journal: Ann Intern Med Date: 2021-03-23 Impact factor: 25.391
Authors: Aoife MacMahon; Sandesh S Rao; Yash P Chaudhry; Syed A Hasan; Jeremy A Epstein; Vishal Hegde; Daniel J Valaik; Julius K Oni; Robert S Sterling; Harpal S Khanuja Journal: HSS J Date: 2021-07-30
Authors: Danny Lee; Ryan Lee; Nikhil B Gowda; William V Probasco; Seth Stake; George Ibrahim; Rajeev Pandarinath Journal: J Clin Orthop Trauma Date: 2019-07-17