Patients with insulin-dependent diabetes may have increased complications after TSA
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Key takeaways:
- Insulin-dependent diabetes was associated with increased complications and readmissions after shoulder arthroplasty.
- These outcomes may guide preoperative counseling and optimization of patients with diabetes.
Results showed patients with insulin-dependent diabetes may have increased risk for postoperative complications and hospital readmissions after total shoulder arthroplasty vs. patients with diabetes and without insulin dependence.
Sam Razaeian, MD, from the department of trauma surgery at Hannover Medical School in Germany, and Dafang Zhang, MD, of the department of orthopedic surgery at Brigham and Women’s Hospital and Harvard Medical School, used the National Surgical Quality Improvement Program database to retrospectively analyze data from 5,888 patients (mean age, 69.8 years) with diabetes mellitus who underwent TSA between 2011 and 2020. They compared outcomes of 1,705 patients with insulin dependence and 4,183 patients without insulin dependence.
According to the study, outcome measures included 30-day postoperative complications, 30-day hospital readmissions, reoperations and mortality.
At 30 days, patients with insulin dependence had an 8.7% complication rate and a 4.8% readmission rate, while patients without insulin dependence had a 5.6% complication rate and a 3.3% readmission rate. No significant differences were seen between the cohorts for reoperations and mortality.
After multivariable logistic regression analysis, researchers found patients with insulin dependence had significantly higher odds of complications (OR = 1.431) and readmissions (OR = 1.379) compared with patients without insulin dependence.
“Our findings are important for the preoperative counseling and optimization of patients with diabetes mellitus considering TSA,” the researchers wrote in the study.
Perspective
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Total shoulder arthroplasty is increasing in prevalence. Overall outcomes are excellent, with most patients achieving a pain-free return to function. That said, complications do occur. Being able to identify groups at higher risk for complications would potentially help prevent or mitigate inferior outcomes.
Sam Razaeian, MD, and Dafang Zhang, MD, are to be commended for their work looking at the effect of insulin dependence on perioperative risk in patients with diabetes undergoing TSA. Several studies have concluded that diabetes mellitus (DM) increases the risk of postoperative complications. What is less clear is whether insulin dependence compounds these risks.
In this paper, the authors retrospectively identified patients with DM undergoing TSA from a national database. Not surprisingly, patients with insulin-dependent diabetes had an even higher rate of complications and readmission post-TSA than patients with non-insulin dependent diabetes. These findings highlight the importance of thorough pre-surgical testing and medical optimization prior to surgery, as well as the necessity for appropriate expectation setting among this patient cohort.
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