Patients with diabetes at higher risk for acute renal failure after hip replacement
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SAN DIEGO — Patients with diabetes mellitus who undergo total hip arthroplasty demonstrate an increased risk for health care use, including increased length of stay, and acute renal failure, according to a speaker at ACR Convergence 2023.
“Diabetes is a common comorbidity in people who undergo total joint replacement and one of the issues diabetics who are undergoing knee and hip replacement have is the risk of infection,” Jasvinder Singh, MD, MPH, of the University of Alabama at Birmingham, told attendees. “One of the issues that has come up is that even the systematic reviews that have been done in this area have had, at most, 50 cases of infection. Infection tends to be so rare after total joint replacement that even in systematic reviews, when you combine every study to date — with diabetics, with an artificial hip, with infection — the total is 50 cases.
“So, we were interested in looking at more contemporary data in some of these studies — very elegant studies — that have been done looking at diabetes,” he added. “We were wondering, with the obesity epidemic and the diabetes rate rising, if things had changed. The recent 2023 AAHKS/ACR guidelines for arthroplasty timing conditionally recommended to delay joint replacement surgery to optimize glycemic control in diabetes, based on low-quality evidence. So, we hope that with our study and others the evidence can improve.”
To examine the effect of diabetes on clinical outcomes and health care use in patients who undergo total hip replacement, based on underlying primary diagnosis, Singh and colleagues analyzed data from individuals in the 2019 National Inpatient Sample. The researchers included patients aged older than 18 years who underwent total hip arthroplasty and stratified them based on primary diagnosis.
The analysis included a total cohort of 591,891 patients, of whom 101,385 were identified as diabetic. The cohort featured 405,691 patients with hip osteoarthritis, 17,060 with avascular necrosis, 104,265 with fracture and 5,720 with inflammatory arthritis, a designation that included rheumatoid arthritis, spondylarthritis and psoriatic arthritis. Those who didn’t fit into any of those categories were stratified as “other.” The researchers performed multivariable-adjusted regression analyses for clinical outcomes and health care use, adjusting for race, age, sex, hospital bed size, census region and teaching status.
According to the researchers, patients with diabetes demonstrated increased length of stay, non-routine discharge and acute renal failure (P .05 each). In addition, patients with OA or fracture alongside diabetes were more likely to demonstrate non-routine discharges (P .001 each). Diabetes was also significantly associated with an increased risk for longer length of stay and acute renal failure among patients with OA, fracture and inflammatory arthritis (P .03 each), the researchers wrote.
Patients with diabetes demonstrated an increased risk for blood transfusions (P = .031), as well as a lower risk for pneumonia and prosthetic complications among those with fracture (P .016 each).
“What we found was that diabetes is associated with more health care utilization, higher rates of infection — both post-procedure infection and periprosthetic joint infection — and blood transfusion,” Singh said. “It seems that the recent AAHKS/ACR guideline of delaying the surgery to achieve optimal glycemic control may be reasonable based on some of these data.
“I think the questions that still remain are, ‘What is glycemic control?’ and ‘How long?’ and ‘What do you need?’ and whether that is appropriate for all patients or for just some group of patients,” he added. “My guess is that we will need a larger dataset than the U.S., or you need more years, or some other approach, or you combine multiple nations to answer those questions, but I think those are very valid questions that still need to be answered. This is not a condition that will have a randomized trial of 5 million people, so it is going to be answered with data like these.”
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Singh J. Abstract 2522. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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