Insulin-Dependence Predicts Surgical Complications and Hospital Admission following Knee Arthroscopy

Abstract

While prior studies have demonstrated that insulin-dependence is an independent risk factor for postoperative complications, morbidity, and mortality following spine and shoulder, hip, and knee arthroplasty, it has not been evaluated in the setting of knee arthroscopy. Therefore, the purpose of this study is to compare the risk of postoperative complications among patients with insulin-dependent diabetes mellitus and noninsulin-dependent diabetes mellitus (IDDM and NIDDM respectively) with the general population following knee arthroscopy. A retrospective analysis of the National Surgical Quality Improvement Program's database for the years 2005 to 2016 was conducted. Logistic regression analyses were used to assess the relationship between diabetic status and outcomes. Multivariate models were established to adjust for age, sex, body mass index, hypertension, congestive heart failure, chronic obstructive pulmonary disease, smoking status, American Society of Anesthesiology classification, and functional status. A total of 86,023 patients were identified. Patients with IDDM were at a much higher risk of surgical complications (odds ratio [OR]: 2.186, 95% confidence interval [CI]: 1.226–1.157), including deep infections (OR: 3.082, 95% CI: 1.753–5.419) and return to operating room [OR] (OR: 1.933, 95% CI: 1.280–2.919), as well as unplanned hospital admission (OR: 1.770, 95% CI: 1.289–2.431). However, NIDDM was not an independent risk factor for subsequent medical or surgical complications, unplanned hospital admission, or 30-day mortality. Patients with IDDM were much more likely to have surgical complications, including deep infection and return to OR, as well as unplanned hospital admission following knee arthroscopy. These risks diminished among those with NIDDM, with their adjusted risk profiles comparable to those without diabetes. Since diabetes occurs in a heterogenous state, more weight should be given to those with insulin-dependence when risk-stratifying patients for surgery. This is a Level III, retrospective comparison study.

Keywords

knee arthroscopy - diabetes - complications - admission - outcomes

• References

• 1 Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003; 290 (14) 1884-1890
• 2 Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87 (01) 4-14
• 3 Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV. Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthroscopy 2016; 32 (12) 2556-2561
• 4 Tsang S-TJ, Gaston P. Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus: a systematic review and meta-analysis of cohort studies. Bone Joint J 2013; 95-B (11) 1474-1479
• 5 Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J 2014; 96-B (12) 1637-1643
• 6 Marchant Jr MH, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 2009; 91 (07) 1621-1629
• 7 Basques BA, Gardner EC, Varthi AG. et al. Risk factors for short-term adverse events and readmission after arthroscopic meniscectomy: does age matter?. Am J Sports Med 2015; 43 (01) 169-175
• 8 Traven SA, Reeves RA, Walton ZJ, Woolf SK, Slone HS. Insulin dependence is associated with increased medical complications and mortality after shoulder arthroscopy. Arthroscopy 2019; 35 (05) 1316-1321
• 9 Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty 2012; 27 (05) 726-9.e1
• 10 Rizvi AA, Chillag SA, Chillag KJ. Perioperative management of diabetes and hyperglycemia in patients undergoing orthopaedic surgery. J Am Acad Orthop Surg 2010; 18 (07) 426-435
• 11 Golinvaux NS, Varthi AG, Bohl DD, Basques BA, Grauer JN. Complication rates following elective lumbar fusion in patients with diabetes: insulin dependence makes the difference. Spine 2014; 39 (21) 1809-1816
• 12 Qin C, Kim JY, Hsu WK. Impact of insulin dependence on lumbar surgery outcomes: an NSQIP analysis of 51,277 patients. Spine 2016; 41 (11) E687-E693
• 13 Lovecchio F, Beal M, Kwasny M, Manning D. Do patients with insulin-dependent and noninsulin-dependent diabetes have different risks for complications after arthroplasty?. Clin Orthop Relat Res 2014; 472 (11) 3570-3575
• 14 Fu MC, Boddapati V, Dines DM, Warren RF, Dines JS, Gulotta LV. The impact of insulin dependence on short-term postoperative complications in diabetic patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26 (12) 2091-2096
• 15 Haider AH, Bilimoria KY, Kibbe MR. A checklist to elevate the science of surgical database research. JAMA Surg 2018; 153 (06) 505-507
• 16 Webb ML, Golinvaux NS, Ibe IK, Bovonratwet P, Ellman MS, Grauer JN. Comparison of perioperative adverse event rates after total knee arthroplasty in patients with diabetes: insulin dependence makes a difference. J Arthroplasty 2017; 32 (10) 2947-2951
• 17 Cancienne JM, Miller MD, Browne JA, Werner BC. Not all patients with diabetes have the same risks: perioperative glycemic control is associated with postoperative infection following knee arthroscopy. Arthroscopy 2018; 34 (05) 1561-1569