title: Do patients with insulin-dependent and noninsulin-dependent diabetes have different risks for complications after arthroplasty?
abstract: BACKGROUND
  Patients with diabetes are known to be at greater risk for complications after arthroplasty than are patients without diabetes. However, we do not know whether there are important differences in the risk of perioperative complications between patients with diabetes who are insulin-dependent (Type 1 or 2) and those who are not insulin-dependent.
  
  
  OBJECTIVE
  The purpose of our study was to compare (1) medical complications (including death), (2) surgical complications, and (3) readmissions within 30 days between patients with insulin-dependent and noninsulin-dependent diabetes, and with patients who do not have diabetes.
  
  
  METHODS
  A total of 43,299 patients undergoing THA or TKA between 2005 and 2011 were selected from the American College of Surgeon's National Surgical Quality Improvement Program's (ACS-NSQIP®) database. Generalized linear models were used to assess the relationship between diabetes status and outcomes (no diabetes [n=36,574], insulin dependent [n=1552], and noninsulin dependent [n=5173]). Multivariate models were established adjusting for confounders including age, sex, race, BMI, smoking, steroid use, hypertension, chronic obstructive pulmonary disease, and anesthesia type. Post hoc comparisons between patient groups were made using a Bonferroni correction.
  
  
  RESULTS
  Patients who were insulin dependent had increased odds of experiencing a medical complication (OR, 1.6; 95% CI, 1.2-2.0; p<0.001), as did patients who were noninsulin dependent (OR, 1.2; 95% CI, 1.1-1.4; p<0.001). An increased likelihood of 30-day mortality was found only for patients who were insulin dependent (OR, 3.74; 95% CI, 1.6-8.5; p=0.007). However, neither diabetic state was associated with surgical complications. Finally, readmission was found to be independently associated with insulin-dependent diabetes (OR, 1.6; 95% CI, 1.1-2.1; p=0.023).
  
  
  CONCLUSIONS
  Patients with insulin-dependent diabetes are most likely to have a medical complication or be readmitted within 30 days after total joint replacement. However, patients who are insulin dependent or noninsulin dependent are no more likely than patients without diabetes to have a surgical complication. Physicians and hospitals should keep these issues in mind when counseling patients and generating risk-adjusted outcome reports.
  
  
  METHODS
  Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Northwestern University Feinberg School of Medicine, 303 East Chicago Ave., Chicago, IL, 60611, USA, f-lovecchio@northwestern.edu.
authors.forename: Francis
authors.initials: F
authors.lastname: Lovecchio
authors.forename: Matthew
authors.initials: M
authors.lastname: Beal
authors.forename: Mary
authors.initials: M
authors.lastname: Kwasny
authors.forename: David
authors.initials: D
authors.lastname: Manning
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001178:Arthroplasty / Q000009:adverse effects / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment